MEDICARE: JIN K MOON L. ACU.

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	198.000509	IL

General Provider Information

NPI Number	:	1134603467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIN K MOON L. ACU.

Provider Business Mailing Address
First Line	:	200 THELIN CT
Second Line	:
City	:	WILMETTE
State	:	IL
Zip	:	60091-3043
Country	:	US
Telephone Number	:	224-616-9472
Fax Number	:

Provider Business Practice Location Address
First Line	:	9933 LAWLER AVE STE 313
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-3783
Country	:	US
Telephone Number	:	224-616-9472
Fax Number	:

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

Provider Enumeration Date	:	09/22/2018
Last Update Date	:	09/22/2018

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