Healthcare Provider Details

I. General information

NPI: 1780068528
Provider Name (Legal Business Name): SEATTLE PAIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16821 SE MCGILLIVRAY BLVD STE 110
VANCOUVER WA
98683-0499
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 360-558-7990
  • Fax: 360-558-7991
Mailing address:
  • Phone: 206-805-8885
  • Fax: 206-805-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number602811689
License Number StateWA

VIII. Authorized Official

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