Individual
CHARLES NAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1701 3RD ST SE, 300, PUYALLUP, WA 98372-4511
(253) 697-5767
Mailing address
1701 3RD ST SE, 300, PUYALLUP, WA 98372-4511
(253) 697-5767
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00032978
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0116426
L & I PROVIDER NUMBER
WA
01
—
5495135
AETNA PROVIDER NUMBER
WA
05
—
8178923
—
WA
01
—
91120349412
KPS PROVIDER NUMBER
WA
01
—
98371B002
TRICARE PROVIDER NUMBER
WA
01
—
NA7328
REGENCE RIDER NUMBER
WA
Enumeration date
05/27/2006
Last updated
11/03/2011
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