Provider Demographics
NPI:1871767632
Name:SEO, SUNG-AH R (MAC LAC)
Entity type:Individual
Prefix:
First Name:SUNG-AH
Middle Name:R
Last Name:SEO
Suffix:
Gender:F
Credentials:MAC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 HUNGERFORD DR
Mailing Address - Street 2:28A
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1714
Mailing Address - Country:US
Mailing Address - Phone:240-593-5404
Mailing Address - Fax:
Practice Address - Street 1:966 HUNGERFORD DR
Practice Address - Street 2:28A
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1714
Practice Address - Country:US
Practice Address - Phone:240-593-5404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01567171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist