Provider Demographics
NPI:1467868257
Name:SEO, KYUNG (DPM)
Entity Type:Individual
Prefix:
First Name:KYUNG
Middle Name:
Last Name:SEO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9105 FRANKLIN SQUARE DR STE 214
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3934
Mailing Address - Country:US
Mailing Address - Phone:443-777-7631
Mailing Address - Fax:
Practice Address - Street 1:9105 FRANKLIN SQUARE DR STE 214
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3934
Practice Address - Country:US
Practice Address - Phone:443-777-7631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA308647213E00000X
PASC006590213ES0103X
MD01762213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist