MEDICARE: JEANNIE SOOK KANG 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	6684	CA

General Provider Information

NPI Number	:	1154462216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNIE SOOK KANG LAC

Provider Business Mailing Address
First Line	:	547 N PLYMOUTH BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-1410
Country	:	US
Telephone Number	:	323-871-4821
Fax Number	:

Provider Business Practice Location Address
First Line	:	822 S ROBERTSON BLVD
Second Line	:	#105
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1613
Country	:	US
Telephone Number	:	310-854-7788
Fax Number	:	310-854-3308

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

Provider Enumeration Date	:	02/10/2007
Last Update Date	:	07/08/2007

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