Provider Demographics
NPI:1578872818
Name:SEO, YOUN SEOK (MD)
Entity Type:Individual
Prefix:
First Name:YOUN
Middle Name:SEOK
Last Name:SEO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 TILLAMOOK TRL
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-4119
Mailing Address - Country:US
Mailing Address - Phone:419-234-4154
Mailing Address - Fax:
Practice Address - Street 1:4840 TILLAMOOK TRL
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-4119
Practice Address - Country:US
Practice Address - Phone:419-234-4154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35. 040660207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology