Healthcare Provider Details

I. General information

NPI: 1356803001
Provider Name (Legal Business Name): LAUREN SEO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 CAMINO ALTO STE 2
MILL VALLEY CA
94941-2219
US

IV. Provider business mailing address

207 DACIAN AVE
DURHAM NC
27701-1901
US

V. Phone/Fax

Practice location:
  • Phone: 415-388-5100
  • Fax: 415-388-5155
Mailing address:
  • Phone: 818-970-7636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number2024-01748
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA204377
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2024-01748
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number323916
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: