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General NPI Number Information
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NPI Number | 1427201326
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Entity Type | Organization
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Legal Business Name | SEO JEONG CORPORATION
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Dates
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Enumeration Date | 10/23/2008
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Last Update Date | 10/23/2008
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Provider Practice Location Address
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Address Line | 16303 S WESTERN AVE SUITE 9
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City | GARDENA
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State | CA
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Zip | 90247-4674
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Country | US
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Telephone | 310-538-9917
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Fax | 310-538-9918
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Provider Business Mailing Address
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Address Line | 16303 S WESTERN AVE SUITE 9
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City | GARDENA
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State | CA
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Zip | 90247-4674
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Country | US
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Telephone | 310-538-9917
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Fax | 310-538-9918
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Authorized Official
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Title or Position | PRESIDENT
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Name | JONGWOON KIM
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Credential | LAC
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Telephone | 310-538-9917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC9925
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License Number State | CA
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