Healthcare Provider Details

I. General information

NPI: 1588113062
Provider Name (Legal Business Name): PAIN CARE PHYSICIANS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 S MILDRED ST STE 102
TACOMA WA
98465-1628
US

IV. Provider business mailing address

801 SW 16TH ST STE. 121
RENTON WA
98057-2697
US

V. Phone/Fax

Practice location:
  • Phone: 206-538-6300
  • Fax: 206-538-6301
Mailing address:
  • Phone: 206-538-6300
  • Fax: 206-538-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number604032151
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number604032151
License Number StateWA

VIII. Authorized Official

Name: KEVIN MOON
Title or Position: DIRECTOR OF REVENUE AND FINANCE
Credential:
Phone: 206-538-6300