Provider Demographics
NPI:1457526063
Name:KEY I. NAM, MD, SC.
Entity Type:Organization
Organization Name:KEY I. NAM, MD, SC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:KEY
Authorized Official - Middle Name:I
Authorized Official - Last Name:NAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-267-0781
Mailing Address - Street 1:3434 W PETERSON AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3319
Mailing Address - Country:US
Mailing Address - Phone:773-267-0781
Mailing Address - Fax:
Practice Address - Street 1:3434 W PETERSON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3319
Practice Address - Country:US
Practice Address - Phone:773-267-0781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036043256225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC41741Medicare UPIN
IL468221Medicare PIN