Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 5797157-4405 | UT |
N | 363LP2300X | Nurse Practitioner - Primary Care | 5797157-4405 | UT |
NPI | 1073903100 |
---|---|
Provider Name | Kyunghee Seo |
First Address | Salt Lake City, UT 84121-1720 |
Second Address | Salt Lake City, UT 84121-1720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2015 |
Last Update Date | 21/08/2015 |