Provider Demographics
NPI:1427127570
Name:GAYTAN, KIMBERLY ANN (PA C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:GAYTAN
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 K ST NW
Mailing Address - Street 2:SUITE 512
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1003
Mailing Address - Country:US
Mailing Address - Phone:202-293-3636
Mailing Address - Fax:202-293-0289
Practice Address - Street 1:2021 K ST NW
Practice Address - Street 2:SUITE 512
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1003
Practice Address - Country:US
Practice Address - Phone:202-293-3636
Practice Address - Fax:202-293-0289
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA30250207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC010926P75Medicare PIN