Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 290456 | NY |
N | 111NI0900X | Internist | 290456 | NY |
NPI | 1003236423 |
---|---|
Provider Name | Dr. Ki Won Seo |
First Address | Plainview, NY 11803-2012 |
Second Address | Plainview, NY 11803-2012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2014 |
Last Update Date | 04/01/2018 |