Provider Demographics
NPI:1750928214
Name:KYUNGHEE SEO K MENTAL HEALTH CLINIC
Entity type:Organization
Organization Name:KYUNGHEE SEO K MENTAL HEALTH CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MS. K
Authorized Official - Prefix:
Authorized Official - First Name:KYUNGHEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:801-602-2645
Mailing Address - Street 1:1160 S STATE ST STE 160A
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-8263
Mailing Address - Country:US
Mailing Address - Phone:801-602-2645
Mailing Address - Fax:
Practice Address - Street 1:1160 S STATE ST STE 160A
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-8263
Practice Address - Country:US
Practice Address - Phone:801-602-2645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-04
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty