Provider Demographics
NPI:1679221618
Name:SON, JOO SEONG (PA-C)
Entity Type:Individual
Prefix:
First Name:JOO SEONG
Middle Name:
Last Name:SON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18988 E SARATOGA CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-4935
Mailing Address - Country:US
Mailing Address - Phone:720-217-2027
Mailing Address - Fax:
Practice Address - Street 1:BLDG S501
Practice Address - Street 2:UNIT #15564
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96224-5564
Practice Address - Country:US
Practice Address - Phone:315-737-3599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant