Provider Demographics
NPI:1992862866
Name:JUN, SEUNGROK NELSON (OD)
Entity Type:Individual
Prefix:DR
First Name:SEUNGROK
Middle Name:NELSON
Last Name:JUN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3560 W CENTURY BLVD
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303-1201
Mailing Address - Country:US
Mailing Address - Phone:310-672-1420
Mailing Address - Fax:310-672-1428
Practice Address - Street 1:3560 W CENTURY BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-1201
Practice Address - Country:US
Practice Address - Phone:310-672-1420
Practice Address - Fax:310-672-1428
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10340T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist