Provider Demographics
NPI:1023038080
Name:SEO, SUK (MD)
Entity Type:Individual
Prefix:
First Name:SUK
Middle Name:
Last Name:SEO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9144 GREENDALE CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-6454
Mailing Address - Country:US
Mailing Address - Phone:916-683-5996
Mailing Address - Fax:
Practice Address - Street 1:200 MED PLAZA
Practice Address - Street 2:SUITE 365, 214
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-301-8708
Practice Address - Fax:310-301-8751
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75729207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A757290OtherMEDICAL PPIN #