Provider Demographics
NPI:1720110968
Name:WALTER K NAHM MD PHD INC
Entity type:Organization
Organization Name:WALTER K NAHM MD PHD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DABBS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:858-278-8835
Mailing Address - Street 1:7695 CARDINAL CT
Mailing Address - Street 2:STE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-3357
Mailing Address - Country:US
Mailing Address - Phone:858-278-8835
Mailing Address - Fax:
Practice Address - Street 1:7695 CARDINAL CT
Practice Address - Street 2:STE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-3357
Practice Address - Country:US
Practice Address - Phone:858-278-8835
Practice Address - Fax:858-386-4776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78569207N00000X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16761Medicare PIN
CAP00353931Medicare PIN