Healthcare Provider Details

I. General information

NPI: 1952765190
Provider Name (Legal Business Name): KAILIN LIEU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 03/02/2024
Certification Date: 03/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 OLD GEORGETOWN RD FL 4
BETHESDA MD
20814-6224
US

IV. Provider business mailing address

7700 OLD GEORGETOWN RD FL 4
BETHESDA MD
20814-6224
US

V. Phone/Fax

Practice location:
  • Phone: 240-482-3200
  • Fax:
Mailing address:
  • Phone: 240-482-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD466879
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberMD466879
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: