Individual
JERRY I NAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4445 MAGNOLIA AVE, RIVERSIDE, CA 92501-4135
(951) 788-3400
(979) 774-7871
Mailing address
4445 MAGNOLIA AVE, RIVERSIDE, CA 92501-4135
(951) 788-3400
(951) 788-3194
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
A65698
CA
2085N0700X
Neuroradiology Physician
J6616
TX
2085R0202X
Diagnostic Radiology Physician
Primary
J6616
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118679302
—
TX
Enumeration date
04/04/2006
Last updated
06/13/2024
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