Provider Demographics
NPI:1962286377
Name:G SEO DENTAL CROP
Entity type:Organization
Organization Name:G SEO DENTAL CROP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GI
Authorized Official - Middle Name:WON
Authorized Official - Last Name:SEO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-359-4032
Mailing Address - Street 1:4933 GOLDEN ARROW DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-3812
Mailing Address - Country:US
Mailing Address - Phone:213-359-4032
Mailing Address - Fax:
Practice Address - Street 1:6598 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-2304
Practice Address - Country:US
Practice Address - Phone:213-359-4032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental