Provider Demographics
NPI:1285903302
Name:SEOL, HAESUN CHUNG (DNP)
Entity type:Individual
Prefix:DR
First Name:HAESUN
Middle Name:CHUNG
Last Name:SEOL
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-4003
Mailing Address - Country:US
Mailing Address - Phone:513-328-5958
Mailing Address - Fax:
Practice Address - Street 1:2515 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-4003
Practice Address - Country:US
Practice Address - Phone:213-384-4555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.009242363LF0000X
CA95006504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily