Individual provider Active NPI

Nick Kwangyeon Nam, DC

  • Chiropractor
  • San Diego, CA
National Provider Identifier
1225785173
Registry record updated Jun 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
34468 Issued in CA
Practice address
7670 Opportunity Rd Ste 150
San Diego, CA 92111-2266
Phone
(858) 900-5467
NPI assigned
Mar 9, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 34468 CA Primary

Addresses

Primary practice location

7670 Opportunity Rd Ste 150
San Diego, CA 92111-2266

Mailing address

9845 Jake LN Apt 10110
San Diego, CA 92126-2855
Phone (858) 869-4397

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240919001558 CA Practitioner - Chiropractic 4385185222 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34468CAMDPeriodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Nick K Nam Chiropractic Apc Chiropractor CurrentSince Aug 7, 2024 Accepting new patients

Locations

3150 E Imperial Hwy
Ste 200
Lynwood, CA 90262
Phone (310) 608-7777

7670 Opportunity Rd
Ste 150
San Diego, CA 92111
Phone (858) 627-9220

7807 Convoy Ct
Ste 105
San Diego, CA 92111

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1646784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749081600000",
    "number": "1225785173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9845 JAKE LN APT 10110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921262855",
            "telephone_number": "858-869-4397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7670 OPPORTUNITY RD STE 150",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921112266",
            "telephone_number": "858-900-5467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAM",
        "first_name": "NICK",
        "middle_name": "KWANGYEON",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-09",
        "last_updated": "2025-06-05",
        "certification_date": "2025-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "34468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.