Provider Demographics
NPI:1225507866
Name:SEO, KYUNG SUK (LMP)
Entity Type:Individual
Prefix:MS
First Name:KYUNG
Middle Name:SUK
Last Name:SEO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 176TH ST SW UNIT 85
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037
Mailing Address - Country:US
Mailing Address - Phone:253-888-0131
Mailing Address - Fax:
Practice Address - Street 1:18904 HWY 99, STE. K
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036
Practice Address - Country:US
Practice Address - Phone:206-801-3894
Practice Address - Fax:206-902-1325
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60720789225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist