Healthcare Provider Details

I. General information

NPI: 1891035465
Provider Name (Legal Business Name): PACIFIC ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 116TH AVE NE SUITE 130
BELLEVUE WA
98004-4640
US

IV. Provider business mailing address

PO BOX 53122
BELLEVUE WA
98015-3122
US

V. Phone/Fax

Practice location:
  • Phone: 425-455-8330
  • Fax: 425-453-7294
Mailing address:
  • Phone: 425-455-8330
  • Fax: 425-453-7294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. SAM TANG
Title or Position: GENERAL MANAGER
Credential:
Phone: 206-323-9917