Individual provider Active NPI

Daniel S Nam, D.D.S.

  • General Practice Dentistry
  • Oakland, CA
National Provider Identifier
1720100886
Registry record updated Sep 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
50328 Issued in CA
Practice address
2976 Summit St Ste 201
Oakland, CA 94609-3405
Phone
(510) 451-8315
Fax
(510) 663-5833
NPI assigned
Apr 6, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 50328 CA Primary

Addresses

Primary practice location

2976 Summit St Ste 201
Oakland, CA 94609-3405

Mailing address

2976 Summit St Ste 201
Oakland, CA 94609-3405
Phone (510) 451-8315

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180906002714 CA Practitioner - Dentist 1951699958

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
50328CAMDPharmacist

Interoperability endpoints

  • Direct secure messaging: dnam195472@hisp.ehr.sutterhealth.org

NPI Registry JSON

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725408000000",
    "number": "1720100886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2976 SUMMIT ST STE 201",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093405",
            "telephone_number": "510-451-8315",
            "fax_number": "510-663-5833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2976 SUMMIT ST STE 201",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093405",
            "telephone_number": "510-451-8315",
            "fax_number": "510-663-5833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAM",
        "first_name": "DANIEL",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-06",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "50328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

Verify at the official NPI Registry.