Basic Information
| Provider Information | |||||||||
| NPI: | 1861739294 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PUGET SOUND PAIN CLINIC PS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 827 | ||||||||
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| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980090827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257741538 | ||||||||
| FaxNumber: | 4257745171 | ||||||||
| Practice Location | |||||||||
| Address1: | 7200 S 180TH ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | TUKWILA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981885548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257741538 | ||||||||
| FaxNumber: | 4257745171 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2013 | ||||||||
| LastUpdateDate: | 01/04/2013 | ||||||||
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| AuthorizedOfficialLastName: | KIM | ||||||||
| AuthorizedOfficialFirstName: | KYONG | ||||||||
| AuthorizedOfficialMiddleName: | HO | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2539839390 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.