Individual
JUNGSOO NAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
330 N JACOB DR, BLOOMINGTON, IN 47404-4823
(812) 323-7595
Mailing address
1001 SHADOW LN, LAS VEGAS, NV 89106-4124
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12014730A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/06/2023
Last updated
05/29/2025
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