Provider Demographics
NPI:1073923272
Name:NAM, MICHAEL (LAC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:NAM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:25212 NARBONNE AVE
Mailing Address - Street 2:APT E
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-2128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 PACIFIC COAST HWY
Practice Address - Street 2:SUITE 210B
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-5993
Practice Address - Country:US
Practice Address - Phone:562-431-6688
Practice Address - Fax:562-431-5800
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC15938171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist