Healthcare Provider Details

I. General information

NPI: 1427520741
Provider Name (Legal Business Name): KIM SPEED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2018
Last Update Date: 12/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3298 FORT LINCOLN DR NE APT 210
WASHINGTON DC
20018-4301
US

IV. Provider business mailing address

1911 M ST NE APT 3
WASHINGTON DC
20002-2004
US

V. Phone/Fax

Practice location:
  • Phone: 202-832-6628
  • Fax:
Mailing address:
  • Phone: 202-380-8945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: