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General NPI Number Information
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NPI Number | 1033384839
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Entity Type | Organization
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Legal Business Name | JOHNNY K. NAM, D.D.S., P.C.
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 9561 BRADDOCK RD
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City | FAIRFAX
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State | VA
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Zip | 22032-2539
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Country | US
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Telephone | 703-323-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 9561 BRADDOCK RD
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City | FAIRFAX
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State | VA
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Zip | 22032-2539
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Country | US
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Telephone | 703-323-6500
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHNNY K NAM
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Credential | D.D.S
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Telephone | 703-323-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401410729
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License Number State | VA
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