Healthcare Provider Details

I. General information

NPI: 1194680488
Provider Name (Legal Business Name): MR. API REDON TIMAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 DIVISION AVE NE
WASHINGTON DC
20019-5457
US

IV. Provider business mailing address

1813 MOUNT PISGAH LN
SILVER SPRING MD
20903-2156
US

V. Phone/Fax

Practice location:
  • Phone: 202-204-1361
  • Fax:
Mailing address:
  • Phone: 240-338-1898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: