Provider Demographics
NPI:1982863437
Name:NAM, ROSELIND SOOJIN (DMD)
Entity Type:Individual
Prefix:
First Name:ROSELIND
Middle Name:SOOJIN
Last Name:NAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23535 NE NOVELTY HILL RD D308
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053
Mailing Address - Country:US
Mailing Address - Phone:425-868-7770
Mailing Address - Fax:425-868-7718
Practice Address - Street 1:23535 NE NOVELTY HILL RD D308
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053
Practice Address - Country:US
Practice Address - Phone:425-868-7770
Practice Address - Fax:425-868-7718
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA610901223X0400X
WADE601396541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics