Provider Demographics
NPI:1811471659
Name:PACIFIC PAIN MEDICAL GROUP, INC
Entity type:Organization
Organization Name:PACIFIC PAIN MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT RECEIVABLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:PHUONG
Authorized Official - Last Name:DU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-656-1324
Mailing Address - Street 1:707 S GARFIELD AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-5861
Mailing Address - Country:US
Mailing Address - Phone:626-282-1600
Mailing Address - Fax:626-656-1324
Practice Address - Street 1:707 S GARFIELD AVE STE 304
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-5861
Practice Address - Country:US
Practice Address - Phone:626-282-1600
Practice Address - Fax:626-656-1324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty