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General NPI Number Information
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NPI Number | 1417584186
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Entity Type | Organization
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Legal Business Name | NAM DENTAL CORPORATION
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 04/03/2020
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Provider Practice Location Address
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Address Line | 3663 W 6TH ST STE 300
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City | LOS ANGELES
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State | CA
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Zip | 90020-3050
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Country | US
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Telephone | 213-352-1080
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Fax | 213-352-1221
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Provider Business Mailing Address
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Address Line | 3663 W 6TH ST STE 300
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City | LOS ANGELES
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State | CA
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Zip | 90020-3050
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Country | US
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Telephone | 213-352-1080
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Fax | 213-352-1221
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Authorized Official
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Title or Position | DENTIST
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Name | EDWARD SUNGWON NAM
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Credential |
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Telephone | 213-604-2816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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