Provider Demographics
NPI:1497023717
Name:SEO, MYUNG CHAN
Entity Type:Individual
Prefix:
First Name:MYUNG CHAN
Middle Name:
Last Name:SEO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1593 SPRING HILL RD STE 115
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2245
Mailing Address - Country:US
Mailing Address - Phone:703-750-0577
Mailing Address - Fax:571-363-2787
Practice Address - Street 1:1593 SPRING HILL RD STE 115
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2245
Practice Address - Country:US
Practice Address - Phone:703-750-0577
Practice Address - Fax:571-363-2787
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA012000508171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist