Provider Demographics
NPI:1093167801
Name:SEO, GI WON (DDS)
Entity Type:Individual
Prefix:
First Name:GI
Middle Name:WON
Last Name:SEO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-1663
Mailing Address - Country:US
Mailing Address - Phone:213-359-4032
Mailing Address - Fax:
Practice Address - Street 1:2418 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-1663
Practice Address - Country:US
Practice Address - Phone:213-359-4032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100326122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist