Provider Demographics
NPI:1497356083
Name:NAM, PYUNG DOO
Entity Type:Individual
Prefix:MR
First Name:PYUNG
Middle Name:DOO
Last Name:NAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7097 ALVERN ST APT D212
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-1867
Mailing Address - Country:US
Mailing Address - Phone:215-808-4521
Mailing Address - Fax:
Practice Address - Street 1:7097 ALVERN ST APT D212
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-1867
Practice Address - Country:US
Practice Address - Phone:215-808-4521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18830171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist