Provider Demographics
NPI:1427201326
Name:SEO JEONG CORPORATION
Entity Type:Organization
Organization Name:SEO JEONG CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONGWOON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:310-538-9917
Mailing Address - Street 1:16303 S WESTERN AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4674
Mailing Address - Country:US
Mailing Address - Phone:310-538-9917
Mailing Address - Fax:310-538-9918
Practice Address - Street 1:16303 S WESTERN AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4674
Practice Address - Country:US
Practice Address - Phone:310-538-9917
Practice Address - Fax:310-538-9918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9925171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC9925OtherCALIFORNIA ACUPUNCTURE LICENSE