Provider Demographics
NPI:1619186939
Name:SEO, KYOUNG H (PT, LAC)
Entity type:Individual
Prefix:MS
First Name:KYOUNG
Middle Name:H
Last Name:SEO
Suffix:
Gender:F
Credentials:PT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11108 WOODSON AVE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1607
Mailing Address - Country:US
Mailing Address - Phone:301-318-9041
Mailing Address - Fax:
Practice Address - Street 1:4829 WEST LN
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-5317
Practice Address - Country:US
Practice Address - Phone:301-318-9041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01847171100000X
MD23597225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist