Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | A75729 | CA |
NPI | 1023038080 |
---|---|
Provider Name | Suk Seo |
First Address | Elk Grove, CA 95758-6454 |
Second Address | Los Angeles, CA 90095-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 12/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A757290 | MEDICAL PPIN # (01) | CA |