Provider Demographics
NPI:1467684738
Name:SEO, YOUNG SUK
Entity Type:Individual
Prefix:
First Name:YOUNG SUK
Middle Name:
Last Name:SEO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 W.ORANGETHORPE AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-4250
Mailing Address - Country:US
Mailing Address - Phone:213-999-3731
Mailing Address - Fax:978-334-5369
Practice Address - Street 1:1649 W ORANGETHORPE AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-4535
Practice Address - Country:US
Practice Address - Phone:714-519-3883
Practice Address - Fax:978-334-5369
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-19
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12672171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist