MEDICARE: DR. SUNGHU KIM LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC14016	CA

General Provider Information

NPI Number	:	1053739011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUNGHU KIM LAC

Provider Business Mailing Address
First Line	:	758 E COLORADO BLVD STE 201
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-2128
Country	:	US
Telephone Number	:	626-356-7561
Fax Number	:	626-628-1894

Provider Business Practice Location Address
First Line	:	758 E COLORADO BLVD STE 201
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-2128
Country	:	US
Telephone Number	:	626-356-7561
Fax Number	:	626-628-1894

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2014
Last Update Date	:	02/05/2016

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