Healthcare Provider Details

I. General information

NPI: 1689912859
Provider Name (Legal Business Name): SEATTLE PAIN AND WELLNESS INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 41ST AVE., SW SUITE 120
SEATTLE WA
98116
US

IV. Provider business mailing address

4701 41ST AVE SW SUITE120
SEATTLE WA
98116-4597
US

V. Phone/Fax

Practice location:
  • Phone: 502-523-3846
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number60084653
License Number StateWA

VIII. Authorized Official

Name: DR. LARRY ZHOU
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 502-523-3846