Healthcare Provider Details

I. General information

NPI: 1841004868
Provider Name (Legal Business Name): VIVLYN MATHIES KIMOU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVENUE, NW, 3RD FLOOR, SUITE 3200
WASHINGTON DC
20060
US

IV. Provider business mailing address

2041 GEORGIA AVENUE, NW, 3RD FLOOR, SUITE 3200
WASHINGTON DC
20060
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-3333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberC0009806
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberC0009806
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberC0009806
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: