Healthcare Provider Details

I. General information

NPI: 1346189313
Provider Name (Legal Business Name): SONGHEE SEO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 QUINCY CT
ALPINE UT
84004-1129
US

IV. Provider business mailing address

389 QUINCY CT
ALPINE UT
84004-1129
US

V. Phone/Fax

Practice location:
  • Phone: 801-833-1199
  • Fax:
Mailing address:
  • Phone: 801-833-1199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-320744
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: