Provider Demographics
NPI:1851544217
Name:NAM, DAVID SOO (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SOO
Last Name:NAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 S VERMONT AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-1686
Mailing Address - Country:US
Mailing Address - Phone:213-427-6070
Mailing Address - Fax:213-427-6077
Practice Address - Street 1:941 S VERMONT AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-1686
Practice Address - Country:US
Practice Address - Phone:213-427-6070
Practice Address - Fax:213-427-6077
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44516122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist