Individual
DR. GLENN KHAM WAKAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4510 EXECUTIVE DR, SAN DIEGO, CA 92121-3021
(800) 926-8273
Mailing address
FILE 57326, LOS ANGELES, CA 90074-7326
(800) 926-8273
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301117353
MI
208600000X
Surgery Physician
Primary
A203171
CA
Other
Enumeration date
06/06/2016
Last updated
09/05/2025
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