Healthcare Provider Details

I. General information

NPI: 1114707726
Provider Name (Legal Business Name): GA YOUNG SEO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GENESIS SEO

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date: 05/06/2024
Reactivation Date: 06/22/2026

III. Provider practice location address

240 SOUTH 40TH STREET OFFICE OF CLINICAL AFFAIRS-S6A EVANS
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

240 SOUTH 40TH STREET OFFICE OF CLINICAL AFFAIRS-S6A EVANS
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 215-573-2588
  • Fax:
Mailing address:
  • Phone: 215-573-2588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: