Provider Demographics
NPI:1720382377
Name:NAM, LINDA (DC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:NAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S VIRGIL AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-4032
Mailing Address - Country:US
Mailing Address - Phone:213-388-3007
Mailing Address - Fax:213-388-3235
Practice Address - Street 1:621 S VIRGIL AVE STE 240
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-4032
Practice Address - Country:US
Practice Address - Phone:213-388-3007
Practice Address - Fax:213-388-3235
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31564111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor