Healthcare Provider Details

I. General information

NPI: 1467447284
Provider Name (Legal Business Name): WALTER K NAHM M.D., PHD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7695 CARDINAL COURT SUITE 200
SAN DIEGO CA
92123-3305
US

IV. Provider business mailing address

7695 CARDINAL CT SUITE 200
SAN DIEGO CA
92123-3357
US

V. Phone/Fax

Practice location:
  • Phone: 858-278-8835
  • Fax: 858-386-4776
Mailing address:
  • Phone: 858-278-8835
  • Fax: 858-386-4776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA78569
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA78569
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA78569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: