Healthcare Provider Details

I. General information

NPI: 1174706337
Provider Name (Legal Business Name): SEUNG-JUN O, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2097 HENRY TECKLENBURG DR SUITE 212 WEST
CHARLESTON SC
29414-5740
US

IV. Provider business mailing address

2097 HENRY TECKLENBURG DR SUITE 212 WEST
CHARLESTON SC
29414-5740
US

V. Phone/Fax

Practice location:
  • Phone: 843-571-4742
  • Fax:
Mailing address:
  • Phone: 843-571-4742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberSC17305
License Number StateSC

VIII. Authorized Official

Name: DR. SEUNG-JUNG O
Title or Position: OWNER
Credential: M.D.
Phone: 843-571-4742