Chungyun Seo, MSW TRAINEE

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

4401 Elenda St
Culver City, CA 90230-4101

Phone

(310) 392-8636

NPI assigned

Sep 13, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Venice Family Clinic

  • Federally Qualified Health Center (FQHC)
  • Culver City, CA
  • NPI 1417490236
  NPD
• Venice Family Clinic

  • Federally Qualified Health Center (FQHC)
  • Hawthorne, CA
  • NPI 1518739515
  NPD (past)

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

{
    "created_epoch": "1631491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661990400000",
    "number": "1578232591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 S LA FAYETTE PARK PL FL 3",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900571607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 ELENDA ST",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902304101",
            "telephone_number": "310-392-8636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEO",
        "first_name": "CHUNGYUN",
        "credential": "MSW TRAINEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-13",
        "last_updated": "2022-09-01",
        "certification_date": "2022-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Agnes Virginia Segar, LMFT
• Elliott P. Seideman, RPH
• Steven Michael Seldon, D.D.S.
• Matthew Lee Seligson
• Senior Care of West L.a. Incorporated
• Stephan Sepernia, MA IN CLINICAL PSYCH
• Sepulveda Pharmacy Inc.
• Diana Carolina Servellon
• Kezia Setiawan
• John Seura

• Student in an Organized Health Care Education/Training Program in Culver City, CA
• Providers in Culver City, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2022; 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.