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General NPI Number Information
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NPI Number | 1497422141
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Entity Type | Individual
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Provider Name | JINWOOK SEO PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 08/29/2021
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 11050 MOUNT BELVEDERE BLVD
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City | FORT DRUM
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State | NY
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Zip | 13602-5438
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Country | US
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Telephone | 315-772-2778
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 305 BOX 387
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City | APO
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State | AP
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Zip | 96218-0004
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Country | US
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Telephone | 315-737-4210
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 028646
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1185908
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License Number State | HI
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