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PRIME CARE, PLLC

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Company Details

Legal Name: PRIME CARE, PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: December 14th 2017
Expiration date: 31 Dec 2025
UBI Number: 604 202 931
ZIP code: 98011
City: Bothell
County: KING
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 11812 N CREEK PKWY N, SUITE 202, BOTHELL, WA, 98011-8202, UNITED STATES
Principal Office Mailing Address: Google Maps Logo 801 SW 16TH ST, SUITE 121, RENTON, WA, 98057-2628, UNITED STATES
Supporting healthcare providers fighting with COVID-19: $11,756

Contact Details

E-Mail: PAUL.SONG@ANESISPAIN.COM
Phone Number: +1 206-769-7798

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role Address
PAUL SONG Registered Agent 801 SW 16TH ST, SUITE 121, RENTON, WA, 98057-2628, UNITED STATES

Key Officers & Management

Name Role Address
JEONG KIM MD Governing Person -
PAUL SONG Governing Person 801 SW 16TH ST, SUITE 121, RENTON, WA, 98057-2628, UNITED STATES
JEONG KIM MD EXECUTOR 3814 222ND PL SE, BOTHELL, WA, 98021-4220, UNITED STATES

National Provider Identifier

NPI Number:
1578035200
Certification Date:
2023-02-09

Authorized Person:

Name:
KEVIN MOON
Role:
CONTRACTING COORDINATOR
Phone:

Taxonomy:

Selected Taxonomy:
208VP0014X - Interventional Pain Medicine Physician
Is Primary:
No
Selected Taxonomy:
363L00000X - Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
363LF0000X - Family Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
207R00000X - Internal Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
2065386301

History

Type Old value New value Date of change
Name change CLEAR SOLUTION CARE, PLLC PRIME CARE, PLLC 2018-10-04
Name change PRIME CARE, PLLC CLEAR SOLUTION CARE, PLLC 2018-07-25
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