Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN611774495 | WA |
NPI | 1174284210 |
---|---|
Provider Name | Joshua Seo |
First Address | Federal Way, WA 98003-3604 |
Second Address | Federal Way, WA 98003-8505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2021 |
Last Update Date | 30/12/2021 |