Provider Demographics
NPI:1114775129
Name:ENOCH NAM MD INC
Entity type:Organization
Organization Name:ENOCH NAM MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENOCH
Authorized Official - Middle Name:H
Authorized Official - Last Name:NAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-222-5476
Mailing Address - Street 1:2700 YGNACIO VALLEY RD STE 150
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3455
Mailing Address - Country:US
Mailing Address - Phone:925-268-0338
Mailing Address - Fax:925-268-0339
Practice Address - Street 1:2700 YGNACIO VALLEY RD STE 150
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3455
Practice Address - Country:US
Practice Address - Phone:925-222-5476
Practice Address - Fax:909-558-2180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-07
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1578799037Medicaid