Provider Demographics
NPI:1609117530
Name:NAM SI DONG, M.D.,INC.
Entity Type:Organization
Organization Name:NAM SI DONG, M.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NAM
Authorized Official - Middle Name:SI
Authorized Official - Last Name:DONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-898-0424
Mailing Address - Street 1:14082 MAGNOLIA ST STE 111
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4764
Mailing Address - Country:US
Mailing Address - Phone:714-898-0424
Mailing Address - Fax:714-459-7325
Practice Address - Street 1:14082 MAGNOLIA ST STE 111
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4764
Practice Address - Country:US
Practice Address - Phone:714-898-0424
Practice Address - Fax:714-459-7325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty