MEDICARE: MISS LILY JOU MTOM, DIPL.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	1238	CO

General Provider Information

NPI Number	:	1265634927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LILY JOU MTOM, DIPL.AC

Provider Business Mailing Address
First Line	:	1735 LAFAYETTE ST
Second Line	:	1ST FLOOR
City	:	DENVER
State	:	CO
Zip	:	80218-1116
Country	:	US
Telephone Number	:	303-875-0557
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 HUDSON ST
Second Line	:	#5
City	:	DENVER
State	:	CO
Zip	:	80220-1454
Country	:	US
Telephone Number	:	520-331-5459
Fax Number	:

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

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	07/08/2007

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