Basic Information
| Provider Information | |||||||||
| NPI: | 1801270269 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEO | ||||||||
| FirstName: | HAN NA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16810 MERIDIAN E STE J107 | ||||||||
| Address2: | |||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983759604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538487777 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 16810 MERIDIAN E STE J107 | ||||||||
| Address2: | |||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983759604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538487777 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2015 | ||||||||
| LastUpdateDate: | 01/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 61166309 | WA | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.