Healthcare Provider Details

I. General information

NPI: 1255903217
Provider Name (Legal Business Name): HYUN JOO NAM CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2021
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 22410
BAKERSFIELD CA
93390-2410
US

IV. Provider business mailing address

10 NEW HVN
IRVINE CA
92620-3285
US

V. Phone/Fax

Practice location:
  • Phone: 503-419-8769
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number323008
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number7277
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: