Provider Demographics
NPI:1467447284
Name:NAHM, WALTER K (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:K
Last Name:NAHM
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7695 CARDINAL CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-3357
Mailing Address - Country:US
Mailing Address - Phone:858-278-8835
Mailing Address - Fax:858-386-4776
Practice Address - Street 1:7695 CARDINAL COURT
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-3305
Practice Address - Country:US
Practice Address - Phone:858-278-8835
Practice Address - Fax:858-386-4776
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78569207ND0101X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00353931OtherRR MEDICARE
CAW16761Medicare ID - Type Unspecified
H88976Medicare UPIN