Healthcare Provider Details

I. General information

NPI: 1639695950
Provider Name (Legal Business Name): SEEUN MOK DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SEEUN SARAH MOK DMD

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12640 HESPERIA RD STE F
VICTORVILLE CA
92395-7753
US

IV. Provider business mailing address

1111 WATERVISTA TER
POOLER GA
31322-5500
US

V. Phone/Fax

Practice location:
  • Phone: 443-285-3992
  • Fax:
Mailing address:
  • Phone: 443-285-3992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number101972
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: