Healthcare Provider Details

I. General information

NPI: 1942079587
Provider Name (Legal Business Name): TIMBERLY'S PEDIATRIC AND ADOLESCENT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 116TH AVE NE STE 104
BELLEVUE WA
98004-3811
US

IV. Provider business mailing address

1515 116TH AVE NE STE 104
BELLEVUE WA
98004-3811
US

V. Phone/Fax

Practice location:
  • Phone: 425-247-3362
  • Fax:
Mailing address:
  • Phone: 425-247-3362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TIMOTHY AHN
Title or Position: OWNER
Credential: ARNP
Phone: 425-247-3362