MEDICARE: HYUN WOOK NAM D.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	122300000X	Dentist	32227	TX
2	1223P0221X	Pediatric Dentistry	109492	CA

General Provider Information

NPI Number	:	1972058964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HYUN WOOK NAM D.M.D.

Provider Business Mailing Address
First Line	:	5701 PARK DR UNIT 9306
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-4958
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6445 PATS RANCH RD STE F
Second Line	:
City	:	JURUPA VALLEY
State	:	CA
Zip	:	91752-4439
Country	:	US
Telephone Number	:	951-228-9328
Fax Number	:

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

Provider Enumeration Date	:	08/18/2016
Last Update Date	:	02/15/2024

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