MEDICARE: MRS. HOSUNG JANE NAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	600695	CA

General Provider Information

NPI Number	:	1275007536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOSUNG JANE NAM

Provider Business Mailing Address
First Line	:	8325 ELK GROVE FLORIN RD STE 800
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95829-9524
Country	:	US
Telephone Number	:	916-226-6190
Fax Number	:

Provider Business Practice Location Address
First Line	:	9728 DEBARNHART WAY # 800
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95757-6234
Country	:	US
Telephone Number	:	650-575-5084
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2019
Last Update Date	:	01/18/2019

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