Provider Demographics
NPI:1578223699
Name:SEO, DONGHAN (LAC)
Entity Type:Individual
Prefix:
First Name:DONGHAN
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 1:12243 QUEENSTON BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-5333
Mailing Address - Country:US
Mailing Address - Phone:281-213-4224
Mailing Address - Fax:
Practice Address - Street 1:12243 QUEENSTON BLVD STE E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-5333
Practice Address - Country:US
Practice Address - Phone:281-213-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC02027171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87-2571190OtherSKY ACUPUNCTURE PLLC