Healthcare Provider Details

I. General information

NPI: 1093167801
Provider Name (Legal Business Name): GI WON SEO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6598 ATLANTIC AVE
LONG BEACH CA
90805-2304
US

IV. Provider business mailing address

6598 ATLANTIC AVE
LONG BEACH CA
90805-2304
US

V. Phone/Fax

Practice location:
  • Phone: 562-617-1234
  • Fax: 562-784-3766
Mailing address:
  • Phone: 562-617-1234
  • Fax: 562-784-3766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number100326
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: