Provider Demographics
NPI:1578730636
Name:SEO, JUNGWOO (DDS)
Entity Type:Individual
Prefix:
First Name:JUNGWOO
Middle Name:
Last Name:SEO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 BARRANCA PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-1725
Mailing Address - Country:US
Mailing Address - Phone:949-861-3131
Mailing Address - Fax:949-387-7600
Practice Address - Street 1:4050 BARRANCA PKWY STE 100
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-1725
Practice Address - Country:US
Practice Address - Phone:949-861-3131
Practice Address - Fax:949-387-7600
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA499901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice