Provider Demographics
NPI:1063621928
Name:SEUL, MI-JEONG (OD)
Entity type:Individual
Prefix:
First Name:MI-JEONG
Middle Name:
Last Name:SEUL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MI-JEONG
Other - Middle Name:
Other - Last Name:SHIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:13165 SUNSET POINT WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-1363
Mailing Address - Country:US
Mailing Address - Phone:310-294-7088
Mailing Address - Fax:
Practice Address - Street 1:1843 1/2 S LA CIENEGA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-4603
Practice Address - Country:US
Practice Address - Phone:323-857-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12475T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist