MEDICARE: SOUTHERN CALIFORNIA UNIVERSITY-SOMA

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	AC4924	CA

General Provider Information

NPI Number	:	1124167382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN CALIFORNIA UNIVERSITY-SOMA

Provider Business Mailing Address
First Line	:	3460 WILSHIRE BLVD STE 500
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2223
Country	:	US
Telephone Number	:	213-413-9500
Fax Number	:	213-413-5400

Provider Business Practice Location Address
First Line	:	3460 WILSHIRE BLVD STE 500
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2223
Country	:	US
Telephone Number	:	213-413-9500
Fax Number	:	213-413-5400

Authorized Official
Title or Position	:	ACADEMIC DEAN
Name	:	MRS. KATHERINE HYUNSOOK CHO
Credential	:	LAC
Telephone Number	:	213-413-9500

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	06/15/2016

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