Healthcare Provider Details

I. General information

NPI: 1023583200
Provider Name (Legal Business Name): DONGWHI SEO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 W BROAD ST
QUAKERTOWN PA
18951-1250
US

IV. Provider business mailing address

6523 BUSTLETON AVE APT 5B
PHILADELPHIA PA
19149-2922
US

V. Phone/Fax

Practice location:
  • Phone: 215-536-1800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP452793
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: