Provider Demographics
NPI:1801673983
Name:SEO, KYONGEUN (DNP)
Entity type:Individual
Prefix:
First Name:KYONGEUN
Middle Name:
Last Name:SEO
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8009 BATTERSEA PL
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-2796
Mailing Address - Country:US
Mailing Address - Phone:201-218-6787
Mailing Address - Fax:
Practice Address - Street 1:8009 BATTERSEA PL
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-2796
Practice Address - Country:US
Practice Address - Phone:201-218-6787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR246277363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner