MEDICARE: PROF. JANE KYUNG OH LISENCED ACUP.

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	AC 9676	CA

General Provider Information

NPI Number	:	1104856418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. JANE KYUNG OH LISENCED ACUP.

Provider Business Mailing Address
First Line	:	303 S GLENOAKS BLVD
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91502-1326
Country	:	US
Telephone Number	:	818-953-9042
Fax Number	:	818-953-9054

Provider Business Practice Location Address
First Line	:	303 S GLENOAKS BLVD
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91502-1319
Country	:	US
Telephone Number	:	818-953-9042
Fax Number	:	818-953-9054

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/08/2007

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