Provider Demographics
NPI:1992037493
Name:CHARLIE Y NAHM MD PROFESSIONAL CORP
Entity Type:Organization
Organization Name:CHARLIE Y NAHM MD PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLIE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:NAHM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-351-2371
Mailing Address - Street 1:9055 SOQUEL DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-4053
Mailing Address - Country:US
Mailing Address - Phone:949-351-2371
Mailing Address - Fax:
Practice Address - Street 1:9055 SOQUEL DR
Practice Address - Street 2:SUITE D
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-4053
Practice Address - Country:US
Practice Address - Phone:949-351-2371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70052207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty