Provider Demographics
NPI:1841791274
Name:SJS, PLLC
Entity Type:Organization
Organization Name:SJS, PLLC
Other - Org Name:PACIFIC URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEJUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-502-6097
Mailing Address - Street 1:29640 MARINE VIEW DR SW
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-3400
Mailing Address - Country:US
Mailing Address - Phone:360-646-8860
Mailing Address - Fax:360-646-8865
Practice Address - Street 1:900 OCEAN BEACH HWY STE B
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4013
Practice Address - Country:US
Practice Address - Phone:360-646-8860
Practice Address - Fax:360-646-8865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038373WA207P00000X
WAPA10003271363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2065309Medicaid
WA367725OtherL&I
OR024277Medicaid