Provider Demographics
NPI:1235367509
Name:NAM, JUNG (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUNG
Middle Name:
Last Name:NAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1691 EL CAMINO REAL STE 200
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1054
Mailing Address - Country:US
Mailing Address - Phone:650-324-1292
Mailing Address - Fax:650-618-1944
Practice Address - Street 1:1691 EL CAMINO REAL STE 200
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1054
Practice Address - Country:US
Practice Address - Phone:650-324-1292
Practice Address - Fax:650-618-1944
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55416122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist