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General NPI Number Information
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NPI Number | 1134107253
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Entity Type | Individual
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Provider Name | SOO JIN NAM DDS
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Gender | Female
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Dates
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Enumeration Date | 01/09/2006
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Last Update Date | 11/01/2022
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Provider Practice Location Address
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Address Line | 4195 PLEASANT HILL RD STE 200
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City | DULUTH
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State | GA
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Zip | 30096-6385
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Country | US
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Telephone | 770-814-7533
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Fax |
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Provider Business Mailing Address
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Address Line | 770 VISTA BLUFF DR
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City | DULUTH
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State | GA
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Zip | 30097
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Country | US
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Telephone | 770-845-4406
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN012863
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License Number State | GA
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