Provider Demographics
NPI:1407132095
Name:PAIN CURE CENTER, INC.
Entity Type:Organization
Organization Name:PAIN CURE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:C
Authorized Official - Last Name:KOO
Authorized Official - Suffix:
Authorized Official - Credentials:MT PRACTITIONER
Authorized Official - Phone:650-996-8168
Mailing Address - Street 1:430 SHERMAN AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1853
Mailing Address - Country:US
Mailing Address - Phone:650-701-7246
Mailing Address - Fax:
Practice Address - Street 1:430 SHERMAN AVE STE 205
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1853
Practice Address - Country:US
Practice Address - Phone:650-701-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13982171100000X
CA24005225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty