=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992680896
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHERRY BLOSSOM FAMILY MEDICINE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2025
-----------------------------------------------------
Last Update Date | 03/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13014 12TH AVE SW
-----------------------------------------------------
City | BURIEN
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98146-3110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-244-5805
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10012 65TH AVE S
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98178-2501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-358-4168
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANDREA BACHHUBER-BEAM
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 956-358-4168
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------