Provider Demographics
NPI:1275007536
Name:NAM, HOSUNG JANE
Entity Type:Individual
Prefix:MRS
First Name:HOSUNG
Middle Name:JANE
Last Name:NAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8325 ELK GROVE FLORIN RD STE 800
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-9524
Mailing Address - Country:US
Mailing Address - Phone:916-226-6190
Mailing Address - Fax:
Practice Address - Street 1:9728 DEBARNHART WAY # 800
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-6234
Practice Address - Country:US
Practice Address - Phone:650-575-5084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA600695163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse