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DR. GLENN KHAM WAKAM MD
NPI 1972952422
Surgery in San Diego, CA

Active since June 06, 2016PECOS EnrolledAccepts Medicare Assignment
4510 EXECUTIVE DR, SAN DIEGO, CA 92121(800) 926-8273 Get Directions Write a Review

NPPES record last updated: September 5, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 5, 2025, Oct 15, 2020, Aug 9, 2019 (3 updates tracked since 2019).

About Dr. Glenn Kham Wakam Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. GLENN KHAM WAKAM MD (NPI 1972952422) is an individual surgery provider in San Diego, California, licensed in California (A203171) and active in the NPI registry since June 2016. He is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of University Of California, San Francisco School Of Medicine (2016).

NPPES Registry Identity

NPI1972952422
Entity TypeIndividualMale
Primary Taxonomy208600000X
Provider Legal NameDR. GLENN KHAM WAKAMCredential: MD
Location Address4510 EXECUTIVE DRSan Diego, CA 92121-3021
Mailing AddressFile 57326Los Angeles, CA 90074-7326 · (800) 926-8273
Phone(800) 926-8273
Sole ProprietorNo
Medical School CMSUniversity Of California, San Francisco School Of MedicineGraduated 2016
Enumeration DateJune 6, 2016
Last NPPES UpdateSeptember 5, 20253 updates tracked since enumeration
NPPES CertifiedSeptember 5, 2025
✔ NPI 1972952422 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians
Taxonomy Code208600000X
License✔ Licensed in CA · A203171
Definition
A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.
Also ListedInternal MedicineTaxonomy 207R00000X · License 4301117353 (MI)
4510 EXECUTIVE DR, San Diego, CA 92121
Open in Google Maps ↗

Secondary Practice Locations 2

Location 13020 Childrens WaySan Diego, CA 92123-4223 · Phone (858) 576-1700
Location 29300 Campus Point DrLA Jolla, CA 92037-1300 · Phone (800) 926-8273

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Glenn Kham Wakam Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3678863313
PECOS Enrollment IDI20250811003527
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92121 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$94.87 typical visit price
range $62.10 – $184.71
Typical copayment $23.71 (range $15.52 – $46.17)
Most-billed visit code 99203
Established Patient
$76.87 typical visit price
range $20.62 – $151.42
Typical copayment $19.21 (range $5.15 – $37.85)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. TODD BENJAMIN PLUTCHOK D.C.
Chiropractor
4510 EXECUTIVE DR, PLAZA 5
SAN DIEGO, CA 92121
San Diego County (858) 452-8888
KHRIZNA CHONG MSN, RN, CNS
Clinical Nurse Specialist (Acute Care)
4510 EXECUTIVE DR
SAN DIEGO, CA 92121
San Diego County (858) 657-7729
MS. SHARON ESTERS-THAMES RN
Registered Nurse
4510 EXECUTIVE DR
SAN DIEGO, CA 92121
San Diego County (858) 450-5000
MISS KERI ANNE O'CONNOR NP
Nurse Practitioner (Family)
4510 EXECUTIVE DR
SAN DIEGO, CA 92121
San Diego County (858) 657-5085
DAVID A LEPAY M.D.
Pathology (Clinical Pathology/Laboratory Medicine)
4510 EXECUTIVE DR, SUITE 2257
SAN DIEGO, CA 92121
San Diego County (858) 550-3850
LISA GUERTIN NP
Nurse Practitioner (Acute Care)
4510 EXECUTIVE DR
SAN DIEGO, CA 92121
San Diego County (800) 926-8273
MANISH V SHETH MD
Psychiatry & Neurology (Psychiatry)
4510 EXECUTIVE DR, SUITE 115
SAN DIEGO, CA 92121
San Diego County (858) 427-5060
DR. CHAD MICHAEL WELLS D.C.
Chiropractor (Sports Physician)
4510 EXECUTIVE DR, PLAZA 5
SAN DIEGO, CA 92121
San Diego County (858) 452-8888

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Glenn Wakam's NPI number?

The NPI number for Glenn Wakam is 1972952422. It was assigned to this individual provider in the NPPES registry on June 6, 2016.

Where is Glenn Wakam located?

Glenn Wakam practices at 4510 Executive Dr, San Diego, CA 92121. The listed phone number is (800) 926-8273.

What is Glenn Wakam's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Is Glenn Wakam enrolled in Medicare?

Yes. Glenn Wakam is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Glenn Wakam was last updated on September 5, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.