Provider Demographics
NPI:1194399014
Name:NAM, MYUNGWOO (MD)
Entity Type:Individual
Prefix:
First Name:MYUNGWOO
Middle Name:
Last Name:NAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 E149TH STREET
Mailing Address - Street 2:SUITE 8-20
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451
Mailing Address - Country:US
Mailing Address - Phone:821-089-4791
Mailing Address - Fax:718-579-4836
Practice Address - Street 1:234 E149TH STREET
Practice Address - Street 2:SUITE 8-20
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451
Practice Address - Country:US
Practice Address - Phone:718-579-4719
Practice Address - Fax:718-579-4836
Is Sole Proprietor?:No
Enumeration Date:2021-05-15
Last Update Date:2022-11-03
Deactivation Date:2022-10-31
Deactivation Code:
Reactivation Date:2022-11-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program