Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jungsoo Nam

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1194501031

Jungsoo Nam is a Student in an Organized Health Care Education/Training Program in Bloomington, Indiana. Works from 2 locations. Licensed in Indiana.

Licensed in
IN
In the registry since
2023
Specialties on file
2

Practice location Address checks out

330 N Jacob Dr
Bloomington, IN 47404-4823
Phone: (812) 323-7595
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1001 Shadow Ln, Las Vegas, NV 89106-4124 — (702) 786-5928

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence 12014730A (IN)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1194501031
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedSeptember 6, 2023
Last updated in NPPESMay 29, 2025
Certification dateMay 29, 2025
Mailing address1001 Shadow Ln, Las Vegas, NV 89106-4124

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