Provider Demographics
NPI:1417734229
Name:DREAM VEIN CLINIC PLLC
Entity Type:Organization
Organization Name:DREAM VEIN CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:JAMIN
Authorized Official - Last Name:KOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-450-6845
Mailing Address - Street 1:900 E PECAN ST STE 300
Mailing Address - Street 2:UNIT 312
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-8049
Mailing Address - Country:US
Mailing Address - Phone:206-450-6845
Mailing Address - Fax:
Practice Address - Street 1:1601 E PFLUGERVILLE PKWY BLDG 3
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2799
Practice Address - Country:US
Practice Address - Phone:206-450-6845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty