Healthcare Provider Details

I. General information

NPI: 1912785205
Provider Name (Legal Business Name): SEUNGROK OH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1962 E PHILLIPS DR
CENTENNIAL CO
80122-3240
US

IV. Provider business mailing address

1962 E PHILLIPS DR
CENTENNIAL CO
80122-3240
US

V. Phone/Fax

Practice location:
  • Phone: 206-778-2492
  • Fax:
Mailing address:
  • Phone: 206-778-2492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN.1624837
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN.1624837
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN.1624837
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: