Provider Demographics
NPI:1205163771
Name:PACIFIC PAIN SPECIALISTS
Entity type:Organization
Organization Name:PACIFIC PAIN SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-601-2097
Mailing Address - Street 1:22510 SE 64TH PLACE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ISSAQUAN
Mailing Address - State:WA
Mailing Address - Zip Code:98027
Mailing Address - Country:US
Mailing Address - Phone:425-391-2722
Mailing Address - Fax:425-391-2922
Practice Address - Street 1:22510 SE 64TH PLACE
Practice Address - Street 2:SUITE 120
Practice Address - City:ISSAQUAN
Practice Address - State:WA
Practice Address - Zip Code:98027
Practice Address - Country:US
Practice Address - Phone:425-391-2722
Practice Address - Fax:425-391-2922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 00047320207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty