Provider Demographics
NPI:1013312610
Name:NAM, JUNGMIN
Entity Type:Individual
Prefix:
First Name:JUNGMIN
Middle Name:
Last Name:NAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HANGANGNO-DONG, YONGSAN-GU
Mailing Address - Street 2:
Mailing Address - City:SEOUL
Mailing Address - State:SOUTH KOREA
Mailing Address - Zip Code:100011
Mailing Address - Country:KR
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 HANGANGNO-DONG, YONGSAN-GU
Practice Address - Street 2:
Practice Address - City:SEOUL
Practice Address - State:SOUTH KOREA
Practice Address - Zip Code:100011
Practice Address - Country:KR
Practice Address - Phone:822-737-4633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202213101183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist