Healthcare Provider Details

I. General information

NPI: 1770416547
Provider Name (Legal Business Name): PACIFIC PEDIATRIC PULMONOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1079 MOANALUA RD STE 555
AIEA HI
96701-4713
US

IV. Provider business mailing address

98-1079 MOANALUA RD STE 555
AIEA HI
96701-4713
US

V. Phone/Fax

Practice location:
  • Phone: 256-289-0873
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY BEATY
Title or Position: OWNER
Credential: MD
Phone: 256-289-0873