Individual provider Active NPI

Suk Seo, MD

  • Gastroenterology Physician
  • Los Angeles, CA
National Provider Identifier
1023038080
Registry record updated Jan 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
A75729 Issued in CA
Practice address
200 Med Plaza
Suite 365, 214
Los Angeles, CA 90095-0001
Phone
(310) 301-8708
Fax
(310) 301-8751
NPI assigned
Jul 20, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 12, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X A75729 CA Primary

Addresses

Primary practice location

200 Med Plaza
Suite 365, 214
Los Angeles, CA 90095-0001

Mailing address

9144 Greendale CT
Elk Grove, CA 95758-6454
Phone (916) 683-5996

Other identifiers 1

IdentifierTypeStateIssuer
00A757290OtherCAMEDICAL PPIN #

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040715000563 CA Practitioner - GastroenterologyPractitioner - Internal Medicine 8628057585 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
University of California, San Diego School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

4501 Sand Creek Rd
Antioch, CA 94531-8687
Phone (925) 813-6500

901 Nevin Ave
Richmond, CA 94801-3143
Phone (510) 307-1500

Hospital & facility affiliations

  • Kaiser Foundation Hospital - Antioch Hospital, Antioch, CA, CCN 050760

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
75729CAMDClinical Social Worker
A75729CAMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Permanente Medical Group Inc Current Accepting new patients
Permanente Medical Group Inc CurrentSince Jul 12, 2010 Accepting new patients

Locations

4501 Sand Creek Rd
Antioch, CA 94531
Phone (925) 813-6420

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641945600000",
    "number": "1023038080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9144 GREENDALE CT",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957586454",
            "telephone_number": "916-683-5996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MED PLAZA",
            "address_2": "SUITE 365, 214",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900950001",
            "telephone_number": "310-301-8708",
            "fax_number": "310-301-8751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEO",
        "first_name": "SUK",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2022-01-12",
        "certification_date": "2022-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CA",
            "license": "A75729",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL PPIN #",
            "identifier": "00A757290",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4501 Sand Creek Rd",
            "city": "Antioch",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945318687",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.