Provider Demographics
NPI:1730637695
Name:TAM, TIMOTHY SHEK-PUI
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:SHEK-PUI
Last Name:TAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 108TH AVE NE STE 700
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8425
Mailing Address - Country:US
Mailing Address - Phone:425-454-1199
Mailing Address - Fax:
Practice Address - Street 1:1231 116TH AVE NE STE 800
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3822
Practice Address - Country:US
Practice Address - Phone:425-214-9372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALF60995078OtherWASHINGTON STATE DEPARTMENT OF HEALTH