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General NPI Number Information
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NPI Number | 1538699475
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Entity Type | Individual
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Provider Name | JAI HYUN NAM
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Gender | Female
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Dates
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Enumeration Date | 06/14/2017
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Last Update Date | 06/13/2021
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Provider Practice Location Address
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Address Line | 269 LIVINGSTON ST STE G
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City | NORTHVALE
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State | NJ
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Zip | 07647-1918
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Country | US
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Telephone | 201-784-1930
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Fax |
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Provider Business Mailing Address
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Address Line | 2030 HUDSON ST APT 1236
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City | FORT LEE
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State | NJ
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Zip | 07024-7227
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Country | US
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Telephone | 617-894-4289
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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 | 060513-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02822600
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License Number State | NJ
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