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ALPHA SPINE AND PAIN CLINIC, PLLC

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Company Details

Legal Name: ALPHA SPINE AND PAIN CLINIC, PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: July 13th 2020
Expiration date: 31 Jul 2026
UBI Number: 604 633 469
ZIP code: 98372
City: Puyallup
County: PIERCE
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 120 14TH AVE SE STE B1, PUYALLUP, WA, 98372-3718, UNITED STATES
Principal Office Mailing Address: Google Maps Logo PO BOX 827, BELLEVUE, WA, 98009-0827, UNITED STATES

Contact Details

E-Mail: ACCOUNTING@WASHINGTONPAIN.COM

Nature of Business

Any Lawful Purpose, Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role Address
JACKY HONG Registered Agent 1900 116TH AVE NE, BELLEVUE, WA, 98004-3052, UNITED STATES

Key Officers & Management

Name Role Address
HYUN HONG Executor 4991 160TH CT SE, BELLEVUE, WA, 98006-4721, UNITED STATES
PRAVEEN MAMBALAM Executor 16490 SE 46TH CT, BELLEVUE, WA, 98006-4740, UNITED STATES
HYUN HONG Governing Person 225 W 520 N, OREM, UT, 84057-4696, UNITED STATES
PRAVEEN MAMBALAM Governing Person -

National Provider Identifier

NPI Number:
1669178984
Certification Date:
2023-02-07

Authorized Person:

Name:
PRAVEEN KUMAR MAMBALAM
Role:
MD
Phone:

Taxonomy:

Selected Taxonomy:
208VP0014X - Interventional Pain Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
8888301615
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