Healthcare Provider Details

I. General information

NPI: 1053575837
Provider Name (Legal Business Name): PREMIER PAIN CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 LAGUNA RD STE A
FULLERTON CA
92835-3614
US

IV. Provider business mailing address

150 LAGUNA RD STE A
FULLERTON CA
92835-3615
US

V. Phone/Fax

Practice location:
  • Phone: 714-525-8822
  • Fax: 714-525-5193
Mailing address:
  • Phone: 714-525-8822
  • Fax: 714-525-5193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. WEI WAH KWOK
Title or Position: CEO
Credential: M.D.
Phone: 714-525-8822