Active NPI
Clifford Wakha Kibang, HHA
- Home Health Aide
- Mount Rainier, MD
National Provider Identifier
1265958276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Aide
- License
- HHA13011
- Practice address
- 3271 Queenstown Drive
Apt #201
Mount Rainier, MD 20712 - Phone
- (240) 413-1428
- NPI assigned
- Aug 21, 2017
- Last updated
- Jul 21, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | HHA13011 | DC | Primary |
Addresses
Primary practice location
3271 Queenstown Drive
Apt #201
Mount Rainier, MD 20712
Mailing address
3271 Queenstown Dr Apt 201
Mount Rainier, MD 20712-1082
Phone (240) 413-1428
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HHA13011 | Medicaid | DC | |
| HHA13011 | Other | DC | DC BOARD OF NURSING |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| HHA13011 | DC | MD | Home Health Aide |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1503273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1265958276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3271 QUEENSTOWN DR APT 201",
"city": "MOUNT RAINIER",
"state": "MD",
"postal_code": "207121082",
"telephone_number": "240-413-1428"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3271 QUEENSTOWN DRIVE",
"address_2": "APT #201",
"city": "MOUNT RAINIER",
"state": "MD",
"postal_code": "20712",
"telephone_number": "240-413-1428"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIBANG",
"first_name": "CLIFFORD",
"middle_name": "WAKHA",
"name_prefix": "Mr.",
"credential": "HHA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-08-21",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": "DC",
"license": "HHA13011",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "HHA13011",
"state": "DC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DC BOARD OF NURSING",
"identifier": "HHA13011",
"state": "DC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mount Rainier, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.