MEDICARE: MS. KYOUNG H. SEO P.T., LAC

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	171100000X	Acupuncturist	U01847	MD
2	225100000X	Physical Therapist	23597	MD

General Provider Information

NPI Number	:	1619186939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KYOUNG H. SEO P.T., LAC

Provider Business Mailing Address
First Line	:	11108 WOODSON AVE
Second Line	:
City	:	KENSINGTON
State	:	MD
Zip	:	20895-1607
Country	:	US
Telephone Number	:	301-318-9041
Fax Number	:

Provider Business Practice Location Address
First Line	:	4829 WEST LN
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-5317
Country	:	US
Telephone Number	:	301-318-9041
Fax Number	:

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	10/22/2013

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