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NPI Code Detail

MEDICARE: MR. DONG WOO NAM

MEDICARE: MR. DONG WOO NAM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1922123686
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DONG WOO NAM
Provider Business Mailing Address
First Line : 1539 E HOWARD ST # 51
Second Line :
City : PASADENA
State : CA
Zip : 91104-2635
Country : US
Telephone Number : 626-296-1332
Fax Number :
Provider Business Practice Location Address
First Line : 8616 LA TIJERA BLVD STE 200
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-3945
Country : US
Telephone Number : 310-337-2805
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2007
Last Update Date : 07/08/2007

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