Provider Demographics
NPI:1538265632
Name:NAM, SOK HWAN (MD)
Entity type:Individual
Prefix:DR
First Name:SOK
Middle Name:HWAN
Last Name:NAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4278 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3449
Mailing Address - Country:US
Mailing Address - Phone:213-366-0388
Mailing Address - Fax:213-368-0389
Practice Address - Street 1:4278 W 3RD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-3449
Practice Address - Country:US
Practice Address - Phone:213-366-0388
Practice Address - Fax:213-368-0389
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71540207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A715400Medicaid
CAH95972Medicare UPIN
CAA71540Medicare ID - Type Unspecified
CA00A715400Medicaid
CA6349790001Medicare NSC