Provider Demographics
NPI:1689729014
Name:ROH, SEON MI (DDS)
Entity Type:Individual
Prefix:
First Name:SEON
Middle Name:MI
Last Name:ROH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 SANTA MONICA BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-4089
Mailing Address - Country:US
Mailing Address - Phone:323-962-2828
Mailing Address - Fax:
Practice Address - Street 1:5520 SANTA MONICA BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-4089
Practice Address - Country:US
Practice Address - Phone:323-962-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44072122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB44072-01OtherDENTI CAL
CA6690OtherPACIFIC UNION