Provider Demographics
NPI:1164422838
Name:SI, SEONGPAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SEONGPAN
Middle Name:
Last Name:SI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 BAY 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-6108
Mailing Address - Country:US
Mailing Address - Phone:718-449-4966
Mailing Address - Fax:718-436-3023
Practice Address - Street 1:5517 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3519
Practice Address - Country:US
Practice Address - Phone:718-436-3023
Practice Address - Fax:718-436-3023
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234283207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02607587Medicaid
748D41Medicare ID - Type Unspecified
NY02607587Medicaid