Provider Demographics
NPI:1790967289
Name:SEO, ALEXANDER YOUNG SOO (LAC PHD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:YOUNG SOO
Last Name:SEO
Suffix:
Gender:M
Credentials:LAC PHD
Other - Prefix:
Other - First Name:YOUNGSOO
Other - Middle Name:
Other - Last Name:SEO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:809 S HOBART BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-2702
Mailing Address - Country:US
Mailing Address - Phone:213-385-3304
Mailing Address - Fax:212-487-2640
Practice Address - Street 1:809 S HOBART BL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-2702
Practice Address - Country:US
Practice Address - Phone:213-385-3304
Practice Address - Fax:212-487-2640
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4920171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist