Provider Demographics
NPI:1861739294
Name:PUGET SOUND PAIN CLINIC PS
Entity type:Organization
Organization Name:PUGET SOUND PAIN CLINIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYONG
Authorized Official - Middle Name:HO
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:253-983-9390
Mailing Address - Street 1:PO BOX 827
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98009-0827
Mailing Address - Country:US
Mailing Address - Phone:425-774-1538
Mailing Address - Fax:425-774-5171
Practice Address - Street 1:7200 S 180TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-5548
Practice Address - Country:US
Practice Address - Phone:425-774-1538
Practice Address - Fax:425-774-5171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty