Healthcare Provider Details

I. General information

NPI: 1881769552
Provider Name (Legal Business Name): WESTCARE CLINIC INC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 TALBOT RD S STE 201
RENTON WA
98055-6294
US

IV. Provider business mailing address

7602 BRIDGEPORT WAY W STE 4A
LAKEWOOD WA
98499-2432
US

V. Phone/Fax

Practice location:
  • Phone: 360-357-9392
  • Fax: 360-528-3049
Mailing address:
  • Phone: 360-357-9392
  • Fax: 360-528-3049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: QUAN HADUONG
Title or Position: OWNER
Credential: MD
Phone: 702-386-4700