Provider Demographics
NPI:1114792439
Name:COASTLINE SPINE AND PAIN CENTER LLC
Entity Type:Organization
Organization Name:COASTLINE SPINE AND PAIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BAO
Authorized Official - Middle Name:N
Authorized Official - Last Name:DINH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-721-8000
Mailing Address - Street 1:4626 MARTIN LUTHER KING JR WAY S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-2135
Mailing Address - Country:US
Mailing Address - Phone:206-721-8000
Mailing Address - Fax:979-256-0818
Practice Address - Street 1:4626 MARTIN LUTHER KING JR WAY S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-2135
Practice Address - Country:US
Practice Address - Phone:206-721-8000
Practice Address - Fax:979-256-0818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty