Healthcare Provider Details

I. General information

NPI: 1679221618
Provider Name (Legal Business Name): JOO SEONG SON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRIAN D. ALLGOOD ARMY COMMUNITY HOSPITAL (BDAACH) UNIT #15245; BLDG 3031
APO AP
96271
US

IV. Provider business mailing address

18988 E SARATOGA CIR
AURORA CO
80015-4935
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-1411
  • Fax:
Mailing address:
  • Phone: 720-217-2027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: