Provider Demographics
NPI:1639695950
Name:MOK, SEEUN (DMD)
Entity type:Individual
Prefix:DR
First Name:SEEUN
Middle Name:
Last Name:MOK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SEEUN
Other - Middle Name:SARAH
Other - Last Name:MOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1111 WATERVISTA TER
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-5500
Mailing Address - Country:US
Mailing Address - Phone:443-285-3992
Mailing Address - Fax:
Practice Address - Street 1:12640 HESPERIA RD STE F
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7753
Practice Address - Country:US
Practice Address - Phone:443-285-3992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1019721223X0400X
CADDS1019721223X0400X
TX33373122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist