1730632761 NPI number — DR. JAESUNG SEO DDS

Table of content: DR. JAESUNG SEO DDS (NPI 1730632761)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730632761 NPI number — DR. JAESUNG SEO DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEO
Provider First Name:
JAESUNG
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730632761
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2050 E ALGONQUIN RD
Provider Second Line Business Mailing Address:
610
Provider Business Mailing Address City Name:
SCHAUMBURG
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60173-4144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-988-4066
Provider Business Mailing Address Fax Number:
847-496-4850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 SAMISH WAY STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98225-6001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-516-4610
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/26/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DENT.DE.60884894 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)