Healthcare Provider Details

I. General information

NPI: 1659301455
Provider Name (Legal Business Name): SEAVER LEE SOON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 4TH AVE
SAN DIEGO CA
92103-4202
US

IV. Provider business mailing address

3737 4TH AVE
SAN DIEGO CA
92103-4202
US

V. Phone/Fax

Practice location:
  • Phone: 619-299-0700
  • Fax: 619-299-0772
Mailing address:
  • Phone: 619-299-0700
  • Fax: 619-299-0772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA95148
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA95148
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: