Provider Demographics
NPI:1154657302
Name:NAM, JEEHAE SOPHIA (EDM)
Entity Type:Individual
Prefix:MS
First Name:JEEHAE
Middle Name:SOPHIA
Last Name:NAM
Suffix:
Gender:F
Credentials:EDM
Other - Prefix:MS
Other - First Name:SOPHIE
Other - Middle Name:
Other - Last Name:NAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EDM
Mailing Address - Street 1:26 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-2827
Mailing Address - Country:US
Mailing Address - Phone:617-665-6385
Mailing Address - Fax:
Practice Address - Street 1:1493 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1047
Practice Address - Country:US
Practice Address - Phone:617-665-6385
Practice Address - Fax:617-665-3449
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2014-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program