Individual provider Active NPI

Grace Hye-Eun Nam, M.D.

  • Pediatrics Physician
  • Washington, DC
National Provider Identifier
1750606521
Registry record updated Aug 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
D0102955 Issued in MD
Practice address
111 Michigan Ave NW Ste M2601
Washington, DC 20010-2916
Phone
(888) 884-2327
Fax
(301) 244-6301
NPI assigned
Apr 5, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A119425 CA
Hospitalist Physician 208M00000X D0102955 MD
Pediatrics Physician 208000000X D0102955 MD Primary

Addresses

Primary practice location

111 Michigan Ave NW Ste M2601
Washington, DC 20010-2916

Mailing address

54701 File Number
Los Angeles, CA 90074-4701
Phone (909) 558-3311

Other practice location 1

9901 Medical Center Dr
Rockville, MD 20850-3357
Phone (240) 826-6000

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150219001112 CA Practitioner - Pediatric Medicine 0042535817 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
119425CAMDClinical Social Worker
A119425CAMDPediatrics Physician
D0102955MDMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Faculty Physicians and Surgeons of Llusm CurrentSince Jan 5, 2015 Accepting new patients
Faculty Physicians and Surgeons of Llusm Pediatrics CurrentSince Jan 5, 2015 Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Diagnostic Imaging Services Past Accepting new patients
Faculty Physicians and Surgeons of Llusm Past Accepting new patients
Adventist Healthcare, Inc. Past Accepting new patients
Sutter Valley Hospitals Past Accepting new patients
JFK Memorial Hospital, Inc. Past Accepting new patients
Children'S Hospital Past Accepting new patients
Loma Linda University Medical Center Past Accepting new patients
Loma Linda University Children'S Hospital Past Accepting new patients

Locations

81 Highland Springs Ave
Ste 103
Beaumont, CA 92223
Phone (909) 558-2830

1505 Wilson Ter
Ste 155
Glendale, CA 91206
Phone (818) 500-4055

7223 Church St
Ste C1
Highland, CA 92346
Phone (909) 425-3946

25845 Barton Rd
Ste F
Loma Linda, CA 92354
Phone (909) 558-2828

11234 Anderson St
Loma Linda, CA 92350
Phone (909) 558-3016

25455 Barton Rd
Ste 108A
Loma Linda, CA 92354
Phone (909) 558-1617

11370 Anderson St
#B100
Loma Linda, CA 92354
Phone (909) 558-2848

11406 Loma Linda Dr
Ste 300
Loma Linda, CA 92354
Phone (909) 558-6277

File Number 54701
Los Angeles, CA 90074
Phone (909) 651-4300

11401 Heacock St
Ste 330
Moreno Valley, CA 92557
Phone (951) 247-8697

11441 Heacock St
Ste C
Moreno Valley, CA 92557
Phone (951) 247-5809

26780 Barton Rd
Redlands, CA 92373
Phone (909) 558-5174

2195 Club Center Dr
Ste A
Sn Bernrdno, CA 92408
Phone (909) 835-1750

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: gnam9612@direct.llu.edu

Organizations & group practices 11

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": "1270425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756080000000",
    "number": "1750606521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54701 FILE NUMBER",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900744701",
            "telephone_number": "909-558-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 MICHIGAN AVE NW STE M2601",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200102916",
            "telephone_number": "888-884-2327",
            "fax_number": "301-244-6301"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9901 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Rockville",
            "state": "MD",
            "postal_code": "208503357",
            "country_code": "US",
            "telephone_number": "240-826-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NAM",
        "first_name": "GRACE",
        "middle_name": "HYE-EUN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-05",
        "last_updated": "2025-08-25",
        "certification_date": "2025-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A119425",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MD",
            "license": "D0102955",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D0102955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

Verify at the official NPI Registry.