Basic Information
Provider Information
NPI: 1386007862
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NAHM
FirstName: BYUNG JOO
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.D.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 31 BEACH ST APT 805
Address2:  
City: BOSTON
State: MA
PostalCode: 021111603
CountryCode: US
TelephoneNumber: 6073515786
FaxNumber: 5166632039
Practice Location
Address1: 200 OLD COUNTRY RD STE 460
Address2:  
City: MINEOLA
State: NY
PostalCode: 115014293
CountryCode: US
TelephoneNumber: 5166632752
FaxNumber: 5166639373
Other Information
ProviderEnumerationDate: 04/01/2016
LastUpdateDate: 04/01/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X63730CAY Dental ProvidersDentistGeneral Practice

No ID Information.


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