Healthcare Provider Details

I. General information

NPI: 1205628484
Provider Name (Legal Business Name): KOALA PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14655 NE BEL RED RD STE 201
BELLEVUE WA
98007-3900
US

IV. Provider business mailing address

8415 SE 35TH ST
MERCER ISLAND WA
98040-3027
US

V. Phone/Fax

Practice location:
  • Phone: 650-933-7151
  • Fax: 920-214-1221
Mailing address:
  • Phone: 650-933-7151
  • Fax: 920-214-1221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: PRIYANKA KAWALI
Title or Position: OWNER
Credential: MD
Phone: 650-933-7151