Provider Demographics
NPI:1508855966
Name:YOUNG, TIMOTHY W (DPM)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:W
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2039 E BEAVER LAKE DR SE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-7920
Mailing Address - Country:US
Mailing Address - Phone:425-391-0208
Mailing Address - Fax:
Practice Address - Street 1:450 NW GILMAN BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2483
Practice Address - Country:US
Practice Address - Phone:425-391-8666
Practice Address - Fax:425-392-6433
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000389213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1013598Medicaid
WAG000106198Medicare ID - Type Unspecified
WA1013598Medicaid