Healthcare Provider Details

I. General information

NPI: 1942637509
Provider Name (Legal Business Name): ANDREW JOHAN SIMON ND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 LEARY AVE NW STE 202
SEATTLE WA
98107
US

IV. Provider business mailing address

5401 LEARY AVE NW STE 202
SEATTLE WA
98107-4070
US

V. Phone/Fax

Practice location:
  • Phone: 206-297-6013
  • Fax: 206-582-3472
Mailing address:
  • Phone: 206-297-6013
  • Fax: 206-582-3472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT60412804
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: