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General NPI Number Information
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NPI Number | 1336724582
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Entity Type | Organization
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Legal Business Name | PACIFIC WEST DIAGNOSTIC IMAGING
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Dates
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Enumeration Date | 03/09/2021
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Last Update Date | 09/29/2022
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Provider Practice Location Address
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Address Line | 12644 INTERURBAN AVE SOUTH,
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City | TUKWILA
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State | WA
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Zip | 98168
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Country | US
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Telephone | 425-654-0887
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Fax | 425-209-0091
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Provider Business Mailing Address
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Address Line | P.O BOX 50187
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City | BELLEVUE
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State | WA
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Zip | 98015
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Country | US
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Telephone | 425-654-0887
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Fax | 425-209-0091
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Authorized Official
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Title or Position | ADMINISTRATIVE
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Name | MRS. BETTY HSU
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Credential |
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Telephone | 425-654-0887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number |
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License Number State |
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