Provider Demographics
NPI:1144613878
Name:PARK WEST PAIN CLINIC INC
Entity Type:Organization
Organization Name:PARK WEST PAIN CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIRVANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNDU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-665-3212
Mailing Address - Street 1:171 BUTCHER RD
Mailing Address - Street 2:#A
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-5656
Mailing Address - Country:US
Mailing Address - Phone:707-474-4433
Mailing Address - Fax:
Practice Address - Street 1:171 BUTCHER RD
Practice Address - Street 2:#A
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-5656
Practice Address - Country:US
Practice Address - Phone:707-474-4433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical