Provider Demographics
NPI:1205278017
Name:JUNG NAM, DMD MSD INC
Entity type:Organization
Organization Name:JUNG NAM, DMD MSD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:NAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:650-324-1292
Mailing Address - Street 1:1691 EL CAMINO REAL STE 200
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1054
Mailing Address - Country:US
Mailing Address - Phone:650-324-1292
Mailing Address - Fax:650-618-1944
Practice Address - Street 1:1691 EL CAMINO REAL STE 200
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1054
Practice Address - Country:US
Practice Address - Phone:650-324-1292
Practice Address - Fax:650-618-1944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55416261QD0000X, 261QD0000X
1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty