Provider Demographics
NPI:1215394374
Name:OUM, SEONG MIN
Entity Type:Individual
Prefix:
First Name:SEONG MIN
Middle Name:
Last Name:OUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11397 ARISTOTLE DR
Mailing Address - Street 2:APT 407
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-0953
Mailing Address - Country:US
Mailing Address - Phone:703-727-9366
Mailing Address - Fax:
Practice Address - Street 1:11397 ARISTOTLE DR
Practice Address - Street 2:APT 407
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-727-9366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02116171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist