Provider Demographics
NPI:1548467962
Name:BACK, NICHOLAS NAMWON (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:NAMWON
Last Name:BACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:225 S LAKE AVE
Mailing Address - Street 2:SUITE 535
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3005
Mailing Address - Country:US
Mailing Address - Phone:626-639-6214
Mailing Address - Fax:626-240-4990
Practice Address - Street 1:225 S LAKE AVE
Practice Address - Street 2:SUITE 535
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3005
Practice Address - Country:US
Practice Address - Phone:626-639-6214
Practice Address - Fax:626-240-4990
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2016-01-07
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Provider Licenses
StateLicense IDTaxonomies
CAA105946207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology