Healthcare Provider Details

I. General information

NPI: 1407690399
Provider Name (Legal Business Name): CODY WHITTED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 05/07/2025
Certification Date: 04/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAN POINT WAY NE, OC.7.830
SEATTLE WA
98105
US

IV. Provider business mailing address

4800 SAND POINT WAY NE OC.7.830
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2525
  • Fax:
Mailing address:
  • Phone: 206-987-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberML61680276
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: