Healthcare Provider Details

I. General information

NPI: 1992632277
Provider Name (Legal Business Name): MR. BUMWOO NAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DANNY NAM

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 MARY & CARL ICE HALL 1310 RESEARCH PARK DR
MANHATTAN KS
66502
US

IV. Provider business mailing address

102 MARY & CARL ICE HALL 1310 RESEARCH PARK DR
MANHATTAN KS
66502
US

V. Phone/Fax

Practice location:
  • Phone: 785-532-1566
  • Fax:
Mailing address:
  • Phone: 785-532-1566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: