Provider Demographics
NPI:1548803166
Name:SEO, JOOWON (LAC)
Entity Type:Individual
Prefix:
First Name:JOOWON
Middle Name:
Last Name:SEO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 LAKEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3006
Mailing Address - Country:US
Mailing Address - Phone:646-596-1858
Mailing Address - Fax:516-775-0548
Practice Address - Street 1:516 LAKEVILLE RD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-3006
Practice Address - Country:US
Practice Address - Phone:646-596-1858
Practice Address - Fax:516-775-0548
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-26
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032205-01225700000X
NY005975171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty