Provider Demographics
NPI:1134686017
Name:BETTER LIFE PAIN CLINIC, PLLC
Entity Type:Organization
Organization Name:BETTER LIFE PAIN CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SU MIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-277-3360
Mailing Address - Street 1:7535 LITTLE RIVER TPKE STE 100C
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2976
Mailing Address - Country:US
Mailing Address - Phone:703-277-3360
Mailing Address - Fax:
Practice Address - Street 1:14804 PHYSICIANS LN STE 121
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3912
Practice Address - Country:US
Practice Address - Phone:703-277-3360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETTER LIFE PAIN CLINIC, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain