Provider Demographics
NPI:1124184973
Name:YI, SEUNG JOHN (MD)
Entity Type:Individual
Prefix:
First Name:SEUNG
Middle Name:JOHN
Last Name:YI
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 1:1601 MILLTOWN RD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4027
Mailing Address - Country:US
Mailing Address - Phone:302-993-2330
Mailing Address - Fax:302-993-2344
Practice Address - Street 1:L6 OMEGA DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2077
Practice Address - Country:US
Practice Address - Phone:302-738-9300
Practice Address - Fax:302-738-3791
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012410012085R0202X
DEC1-00084002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE003384P97Medicare PIN
DE003825D14Medicare PIN
DE003383M26Medicare PIN
DE003386B93Medicare PIN
DE003387G66Medicare PIN
DE003385O73Medicare PIN
DE004036O31Medicare PIN