MEDICARE: DR. NICHOLAS NAMWON BACK M.D.

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	207L00000X	Anesthesiology Physician	A105946	CA

General Provider Information

NPI Number	:	1548467962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS NAMWON BACK M.D.

Provider Business Mailing Address
First Line	:	225 S LAKE AVE
Second Line	:	SUITE 535
City	:	PASADENA
State	:	CA
Zip	:	91101-3005
Country	:	US
Telephone Number	:	626-639-6214
Fax Number	:	626-240-4990

Provider Business Practice Location Address
First Line	:	225 S LAKE AVE
Second Line	:	SUITE 535
City	:	PASADENA
State	:	CA
Zip	:	91101-3005
Country	:	US
Telephone Number	:	626-639-6214
Fax Number	:	626-240-4990

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

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	01/07/2016

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