Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIR008082 | GA |
N | 111NI0013X | Independent Medical Examiner | CHIR008082 | GA |
NPI | 1538548730 |
---|---|
Provider Name | Kikwang Nam |
First Address | Johns Creek, GA 30097-1505 |
Second Address | Johns Creek, GA 30097-1505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2015 |
Last Update Date | 21/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013249978 | NPI (01) | GA |