MEDICARE: TAO OF MEDICINE INC.

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

General Provider Information

NPI Number	:	1114528742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAO OF MEDICINE INC.

Provider Business Mailing Address
First Line	:	2901 WILSHIRE BLVD STE 335
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-4930
Country	:	US
Telephone Number	:	310-401-3347
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 WILSHIRE BLVD STE 335
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-4930
Country	:	US
Telephone Number	:	310-401-3347
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. HOON CHEOL KIM
Credential	:	LAC
Telephone Number	:	310-401-3347

Provider Enumeration Date	:	11/02/2020
Last Update Date	:	11/02/2020

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