MEDICARE: SEOUL ANESTHESIOLOGY CONSULTANT INC

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	207L00000X	Anesthesiology Physician		NV

General Provider Information

NPI Number	:	1346605052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEOUL ANESTHESIOLOGY CONSULTANT INC

Provider Business Mailing Address
First Line	:	DEPT 880003 P.O. BOX 29650
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85038-9650
Country	:	US
Telephone Number	:	908-653-1283
Fax Number	:	908-653-9305

Provider Business Practice Location Address
First Line	:	9901 LIBERTY VIEW RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5507
Country	:	US
Telephone Number	:	908-653-1283
Fax Number	:	908-653-9305

Authorized Official
Title or Position	:	ANESTHESIOLOGY
Name	:	MR. NAM HOON PARK
Credential	:
Telephone Number	:	908-653-9399

Provider Enumeration Date	:	12/22/2015
Last Update Date	:	12/22/2015

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