Provider Demographics
NPI:1790007086
Name:JONG-BUM SEO AND YVONNE LEE, D.M.D., P.A.
Entity type:Organization
Organization Name:JONG-BUM SEO AND YVONNE LEE, D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONG-BUM
Authorized Official - Middle Name:
Authorized Official - Last Name:SEO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:410-922-5500
Mailing Address - Street 1:9944 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-1804
Mailing Address - Country:US
Mailing Address - Phone:410-922-5500
Mailing Address - Fax:410-922-5537
Practice Address - Street 1:9944 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-1804
Practice Address - Country:US
Practice Address - Phone:410-922-5500
Practice Address - Fax:410-922-5537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-27
Last Update Date:2010-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14142122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty