Provider Demographics
NPI:1750671822
Name:PAIN & INJURY CLINIC PS
Entity Type:Organization
Organization Name:PAIN & INJURY CLINIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HASANOGLU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-251-9900
Mailing Address - Street 1:PO BOX 60164
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-3164
Mailing Address - Country:US
Mailing Address - Phone:425-251-9900
Mailing Address - Fax:425-251-9909
Practice Address - Street 1:330 SW 43RD ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4900
Practice Address - Country:US
Practice Address - Phone:425-251-9900
Practice Address - Fax:425-251-9909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602972064208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty