Provider Demographics
NPI:1104429216
Name:SEO, JU-YEON
Entity type:Individual
Prefix:
First Name:JU-YEON
Middle Name:
Last Name:SEO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13031 LEE JACKSON HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2050
Mailing Address - Country:US
Mailing Address - Phone:703-378-7550
Mailing Address - Fax:703-378-4459
Practice Address - Street 1:13031 LEE JACKSON HWY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2050
Practice Address - Country:US
Practice Address - Phone:703-378-7550
Practice Address - Fax:703-378-4459
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202216166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist