Healthcare Provider Details

I. General information

NPI: 1679430227
Provider Name (Legal Business Name): KAI ISATU ETHEL YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4017 MINNESOTA AVE NE
WASHINGTON DC
20019-3541
US

IV. Provider business mailing address

5403 NACY LEE LN
UPPER MARLBORO MD
20772-7402
US

V. Phone/Fax

Practice location:
  • Phone: 202-388-9202
  • Fax: 202-388-4339
Mailing address:
  • Phone: 301-979-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: