MEDICARE: GRACE JUNG L.AC.

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	AC13686	CA

General Provider Information

NPI Number	:	1154690824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE JUNG L.AC.

Provider Business Mailing Address
First Line	:	3832 WILSHIRE BLVD STE 103
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3220
Country	:	US
Telephone Number	:	213-210-1803
Fax Number	:	213-529-4086

Provider Business Practice Location Address
First Line	:	3832 WILSHIRE BLVD STE 103
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3220
Country	:	US
Telephone Number	:	213-388-8820
Fax Number	:	213-529-4086

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

Provider Enumeration Date	:	12/23/2011
Last Update Date	:	11/04/2025

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