MEDICARE: DR. JIN SEO O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	35426	CA

General Provider Information

NPI Number	:	1487347019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIN SEO O.D.

Provider Business Mailing Address
First Line	:	750 S OXFORD AVE APT 410
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-4628
Country	:	US
Telephone Number	:	704-962-5277
Fax Number	:

Provider Business Practice Location Address
First Line	:	3525 W 8TH ST STE 107
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-5030
Country	:	US
Telephone Number	:	213-999-1046
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2023
Last Update Date	:	04/19/2025

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