Provider Demographics
NPI:1760774970
Name:KLINE, SUZIE SEOYANG (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SUZIE
Middle Name:SEOYANG
Last Name:KLINE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SEOYANG
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 SOUTH FAIR OAKS AVE
Mailing Address - Street 2:#100
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105
Mailing Address - Country:US
Mailing Address - Phone:626-397-2537
Mailing Address - Fax:626-397-2147
Practice Address - Street 1:2428 SANTA MONICA BLVD
Practice Address - Street 2:#208
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2045
Practice Address - Country:US
Practice Address - Phone:310-998-9118
Practice Address - Fax:310-829-9318
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9115171100000X
CA19208261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No171100000XOther Service ProvidersAcupuncturist