Provider Demographics
NPI:1205805843
Name:NAM, JONG HYUN (MD)
Entity type:Individual
Prefix:DR
First Name:JONG HYUN
Middle Name:
Last Name:NAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JONG
Other - Middle Name:
Other - Last Name:NAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:815 SUMNEYTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-5390
Mailing Address - Country:US
Mailing Address - Phone:215-257-5071
Mailing Address - Fax:215-257-1801
Practice Address - Street 1:815 SUMNEYTOWN PIKE
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-5390
Practice Address - Country:US
Practice Address - Phone:215-257-5071
Practice Address - Fax:215-257-1801
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419864207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAI44585Medicare UPIN
PA177389GGEMedicare ID - Type Unspecified