Joanna Haewon Seo, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4291-22 Issued in MS

Practice address

2500 North State Street
School of Dentistry - Advanced General Dentistry
Jackson, MS 39216

Phone

(601) 984-6028

NPI assigned

Jun 7, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Joanna Haewon Seo Han Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Networks

• LA PPO C-SNP

Interoperability endpoints

• Direct secure messaging: jseo135478@ummc.direct-ci.com

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.

• University Physicians, PLLC

  • Internal Medicine Physician
  • Jackson, MS
  • NPI 1609984574
  NPD (past)

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

{
    "created_epoch": "1654560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701820800000",
    "number": "1104555093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-815-3156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 NORTH STATE STREET",
            "address_2": "SCHOOL OF DENTISTRY - ADVANCED GENERAL DENTISTRY",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39216",
            "telephone_number": "601-984-6028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEO",
        "first_name": "JOANNA",
        "middle_name": "HAEWON",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-07",
        "last_updated": "2023-12-06",
        "certification_date": "2023-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "4291-22",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOANNA",
            "last_name": "HAN",
            "middle_name": "HAEWON SEO",
            "credential": "DMD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Bruce Stocker Senter, MD
• Suzanne Senter, MD
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• Serenity Home Health Care
• Cheryl Lynn Serio, D.D.S.
• Andrea Serpas, MD
• Hannah Servis

• General Practice Dentistry in Jackson, MS
• Providers in Jackson, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.