Healthcare Provider Details

I. General information

NPI: 1629915079
Provider Name (Legal Business Name): SEO YOUNG KO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2056 SEAVIEW DR
FULLERTON CA
92833-1223
US

IV. Provider business mailing address

2056 SEAVIEW DR
FULLERTON CA
92833-1223
US

V. Phone/Fax

Practice location:
  • Phone: 714-213-9866
  • Fax:
Mailing address:
  • Phone: 714-213-9866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number20630
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: