| Organization Name: | JUNG NAM, DMD MSD INC |
| NPI Number: | 1205278017 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JUNG NAM (CEO) |
| Mailing Address: | 1848 Saratoga Ave Suite 6b Saratoga |
| State: | CA US |
| Postal Code: | 950706612 |
| Phone Number: | 4088711211 |
| Fax Number: | 4088711245 |
| NPI Enumeration Date: | 07/22/2013 |
| NPI Last Update Date: | 02/16/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 55416 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |