MEDICARE: DR. KENNETH Y CHOI 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	AC3774	CA

General Provider Information

NPI Number	:	1164632295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH Y CHOI AC

Provider Business Mailing Address
First Line	:	3750 W 6TH ST STE 203
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-5107
Country	:	US
Telephone Number	:	213-365-0781
Fax Number	:	818-366-7078

Provider Business Practice Location Address
First Line	:	3750 W 6TH ST STE 203
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-5107
Country	:	US
Telephone Number	:	213-365-0781
Fax Number	:	818-366-7078

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2007

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