Individual
KYUNG NAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6701 EDGEMOOR WAY, SAN JOSE, CA 95129-2933
(408) 464-1912
Mailing address
6701 EDGEMOOR WAY, SAN JOSE, CA 95129-2933
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
106717
CA
Other
Enumeration date
08/03/2021
Last updated
08/03/2021
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