Healthcare Provider Details

I. General information

NPI: 1720110968
Provider Name (Legal Business Name): WALTER K NAHM MD PHD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

7695 CARDINAL CT STE 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:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAMES DABBS JR.
Title or Position: OFFICE MANAGER
Credential:
Phone: 858-278-8835