MEDICARE: HYESEON SEO NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	95031551	CA

General Provider Information

NPI Number	:	1174342794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HYESEON SEO NP

Provider Business Mailing Address
First Line	:	4436 W 163RD ST
Second Line	:
City	:	LAWNDALE
State	:	CA
Zip	:	90260-2937
Country	:	US
Telephone Number	:	310-590-9387
Fax Number	:

Provider Business Practice Location Address
First Line	:	12665 GARDEN GROVE BLVD STE 503
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1919
Country	:	US
Telephone Number	:	714-530-3740
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	02/06/2026

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Directions to “ HYESEON SEO NP” Practice Location

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