Provider Demographics
NPI:1538548730
Name:NAM, KIKWANG (DC)
Entity type:Individual
Prefix:
First Name:KIKWANG
Middle Name:
Last Name:NAM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 MEDLOCK BRIDGE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1505
Mailing Address - Country:US
Mailing Address - Phone:770-418-2340
Mailing Address - Fax:770-418-9011
Practice Address - Street 1:10900 MEDLOCK BRIDGE RD STE 202
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1505
Practice Address - Country:US
Practice Address - Phone:770-418-2340
Practice Address - Fax:770-418-9011
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008082111N00000X, 111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1013249978OtherNPI
GA1013249978OtherNPI