Provider Demographics
NPI:1245215144
Name:JO, WON-SEOK (MD)
Entity Type:Individual
Prefix:DR
First Name:WON-SEOK
Middle Name:
Last Name:JO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:424 E VANDERBILT WAY STE B
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3552
Mailing Address - Country:US
Mailing Address - Phone:909-796-0363
Mailing Address - Fax:909-255-7292
Practice Address - Street 1:424 E VANDERBILT WAY STE B
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3552
Practice Address - Country:US
Practice Address - Phone:909-796-0363
Practice Address - Fax:909-255-7292
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91260207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH93420Medicare UPIN