Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 17305 | SC |
NPI | 1215042155 |
---|---|
Provider Name | Seung-Jun O |
First Address | Charleston, SC 29414-5740 |
Second Address | Charleston, SC 29414-5740 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 05/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
173056 | (05) | SC |
G23423 | (02) | SC |