MEDICARE: SEUNG WON HONG MA

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	106H00000X	Marriage & Family Therapist
2	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1912104647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEUNG WON HONG MA

Provider Business Mailing Address
First Line	:	20695 S WESTERN AVE STE 132
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90501-1834
Country	:	US
Telephone Number	:	424-271-7414
Fax Number	:

Provider Business Practice Location Address
First Line	:	20695 S WESTERN AVE STE 132
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90501-1834
Country	:	US
Telephone Number	:	424-271-7414
Fax Number	:

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

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	01/26/2022

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