Provider Demographics
NPI:1841563731
Name:NAM, DANIEL SANG (LAC, PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:SANG
Last Name:NAM
Suffix:
Gender:M
Credentials:LAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15069 HEATHER LN
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-5260
Mailing Address - Country:US
Mailing Address - Phone:951-674-0194
Mailing Address - Fax:
Practice Address - Street 1:32245 MISSION TRL
Practice Address - Street 2:SUITE D6
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4528
Practice Address - Country:US
Practice Address - Phone:951-674-8683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL.AC. 5993171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist