Individual provider Active NPI

Youngseong Seo

  • Clinical Social Worker
  • Oakland, CA
National Provider Identifier
1851158158
Registry record updated Mar 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW108993 Issued in CA
Practice address
510 17TH St
Oakland, CA 94612-1553
Phone
(510) 830-3929
NPI assigned
Mar 4, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCSW108993 CA Primary

Addresses

Primary practice location

510 17TH St
Oakland, CA 94612-1553

Mailing address

510 17TH St
Oakland, CA 94612-1553
Phone (510) 830-3929

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240403000968 CA Practitioner - Clinical Social Worker 9133567621 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW108993CAMDClinical Social Worker
108993CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Well Mental Health Counseling Licensed Clinical Social Worker Inc CurrentSince Mar 14, 2024 Accepting new patients

Locations

6281 Beach Blvd
Ste 304
Buena Park, CA 90621
Phone (213) 331-7774

6 Centerpointe Dr
Ste 700
La Palma, CA 90623
Phone (213) 331-7774

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1709510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709510400000",
    "number": "1851158158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 17TH ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946121553",
            "telephone_number": "510-830-3929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 17TH ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946121553",
            "telephone_number": "510-830-3929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEO",
        "first_name": "YOUNGSEONG",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-03-04",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW108993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

Verify at the official NPI Registry.