Active NPI
David Ki Nam, MD
- Diagnostic Radiology Physician
- Los Angeles, CA
National Provider Identifier
1760184782
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- PTL12760
- Practice address
- 4733 W Sunset Blvd FL 3
Los Angeles, CA 90027-6021 - Phone
- (323) 783-4516
- NPI assigned
- Mar 21, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | PTL12760 | CA | Primary |
Addresses
Primary practice location
4733 W Sunset Blvd FL 3
Los Angeles, CA 90027-6021
Mailing address
200 W Arbor Drive, Mail Code 8756
San Diego, CA 92103-1911
Phone (619) 543-3534
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq | Health Information Exchange (HIE) | Southern California Permanente Medical Group |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTL12760 | CA | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719792000000",
"number": "1760184782",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 W ARBOR DRIVE, MAIL CODE 8756",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921031911",
"telephone_number": "619-543-3534"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4733 W SUNSET BLVD FL 3",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900276021",
"telephone_number": "323-783-4516"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NAM",
"first_name": "DAVID",
"middle_name": "KI",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-03-21",
"last_updated": "2024-07-01",
"certification_date": "2024-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "CA",
"license": "PTL12760",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
"affiliation": "Y",
"endpointDescription": "Carequality",
"affiliationName": "Southern California Permanente Medical Group",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "C-CDA",
"address_1": "4733 W Sunset Blvd",
"city": "Los Angeles",
"state": "CA",
"country_code": "US",
"postal_code": "900276021",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.