Healthcare Provider Details

I. General information

NPI: 1730526641
Provider Name (Legal Business Name): SEATTLE PAIN CENTER MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 S MILDRED ST SUITE 105
TACOMA WA
98465-1627
US

IV. Provider business mailing address

801 SW 16TH ST. STE. 121
RENTON WA
98057-2628
US

V. Phone/Fax

Practice location:
  • Phone: 253-448-8170
  • Fax: 425-793-5256
Mailing address:
  • Phone: 206-805-8885
  • Fax: 206-805-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANK DANGER LI
Title or Position: CEO/OWNER
Credential: MD
Phone: 206-805-8885