Healthcare Provider Details

I. General information

NPI: 1336094077
Provider Name (Legal Business Name): SEINE YOO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10215 FERNWOOD RD STE 506
BETHESDA MD
20817-1184
US

IV. Provider business mailing address

10215 FERNWOOD RD STE 506
BETHESDA MD
20817-1184
US

V. Phone/Fax

Practice location:
  • Phone: 301-530-1010
  • Fax: 301-897-8597
Mailing address:
  • Phone: 301-530-1010
  • Fax: 301-897-8597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number30775
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: