Provider Demographics
NPI:1992868905
Name:NAM, BOKNAM B (LAC)
Entity type:Individual
Prefix:
First Name:BOKNAM
Middle Name:B
Last Name:NAM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:NAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:103 S. VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-5904
Mailing Address - Country:US
Mailing Address - Phone:213-380-5300
Mailing Address - Fax:213-380-0234
Practice Address - Street 1:103 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-5904
Practice Address - Country:US
Practice Address - Phone:213-380-5300
Practice Address - Fax:213-380-0234
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5190171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist