Provider Demographics
NPI:1033374749
Name:PACIFIC PSYCHIATRIC CONSULTING PLLC
Entity Type:Organization
Organization Name:PACIFIC PSYCHIATRIC CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:SUPRIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-749-5008
Mailing Address - Street 1:24001 56TH AVE W
Mailing Address - Street 2:SUITE D404
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-5558
Mailing Address - Country:US
Mailing Address - Phone:425-749-5008
Mailing Address - Fax:866-305-0497
Practice Address - Street 1:24001 56TH AVE W
Practice Address - Street 2:SUITE D404
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-5558
Practice Address - Country:US
Practice Address - Phone:425-749-5008
Practice Address - Fax:866-305-0497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047610261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health