Provider Demographics
NPI:1851409189
Name:NAM, KUN WOO (MD)
Entity Type:Individual
Prefix:DR
First Name:KUN
Middle Name:WOO
Last Name:NAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4143 FULTON DR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2819
Mailing Address - Country:US
Mailing Address - Phone:330-244-8888
Mailing Address - Fax:330-244-8850
Practice Address - Street 1:1441 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-4245
Practice Address - Country:US
Practice Address - Phone:330-244-8888
Practice Address - Fax:330-244-8850
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044948207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0427845Medicaid
F37421Medicare UPIN
NA0724821Medicare ID - Type Unspecified