Most Relevant Information
Provider Data
| NPI Number: | 1003305160 |
| Provider Name: | LEAH SOOYEON NAM DMD |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/04/2018 |
| Last Updated: | 05/04/2018 |
Provider Practice Location
110 BERGEN ST
NEWARK
NJ
071032495
Practice Location Phone/Fax
| Phone: | 9739729592 |
| Fax: |
Provider Mailing Location
333 1ST ST APT A
PALISADES PARK
NJ
076502676
Provider Mailing Phone/Fax
| Phone: | 2017053203 |
| Fax: |