Healthcare Provider Details

I. General information

NPI: 1366253577
Provider Name (Legal Business Name): KAITLYN KING LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYN NICOLE KING

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

925 S GLEBE RD APT 229
ARLINGTON VA
22204-2654
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-2000
  • Fax:
Mailing address:
  • Phone: 252-775-1557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP500021067
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: