Provider Demographics
NPI:1679268551
Name:SEO, SEUNGLIN (PH D)
Entity Type:Individual
Prefix:
First Name:SEUNGLIN
Middle Name:
Last Name:SEO
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11313 DUNLEITH PL
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2566
Mailing Address - Country:US
Mailing Address - Phone:301-335-7279
Mailing Address - Fax:
Practice Address - Street 1:14650 ROTHGEB DR STE D
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-5391
Practice Address - Country:US
Practice Address - Phone:240-477-3866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000310171100000X
DCAC30078171100000X
MDU00923171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist