Provider Demographics
NPI:1518997550
Name:MCGINNIS, SEONG (MD)
Entity Type:Individual
Prefix:
First Name:SEONG
Middle Name:
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2168
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-2168
Mailing Address - Country:US
Mailing Address - Phone:775-445-8790
Mailing Address - Fax:775-445-7611
Practice Address - Street 1:10539 PROFESSIONAL CIR
Practice Address - Street 2:STE 200
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-3858
Practice Address - Country:US
Practice Address - Phone:775-445-7026
Practice Address - Fax:775-828-2344
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9557207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV004716904Medicaid