Provider Demographics
NPI:1639695950
Name:MOK, SE EUN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SE EUN
Middle Name:
Last Name:MOK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SEEUN
Other - Middle Name:SARAH
Other - Last Name:MOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:5600 WILSHIRE BLVD APT 518
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3782
Mailing Address - Country:US
Mailing Address - Phone:443-285-3992
Mailing Address - Fax:
Practice Address - Street 1:2629 E GAGE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4121
Practice Address - Country:US
Practice Address - Phone:323-588-8252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33373122300000X
CA101972122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist