Provider Demographics
NPI:1194381905
Name:WASHINGTON CENTER FOR PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:WASHINGTON CENTER FOR PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACKY
Authorized Official - Middle Name:
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-774-1538
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:
Practice Address - Street 1:120 14TH AVE SE STE B
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3718
Practice Address - Country:US
Practice Address - Phone:425-774-1538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON CENTER FOR PAIN MANAGEMENT PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-16
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center