MEDICARE: JOHN KWANGDEOK PAIK LAC. DOM

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	AC7383	CA

General Provider Information

NPI Number	:	1275675977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN KWANGDEOK PAIK LAC. DOM

Provider Business Mailing Address
First Line	:	2015 CAMWOOD AVE
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-4047
Country	:	US
Telephone Number	:	626-922-9492
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 CAMWOOD AVE
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-4047
Country	:	US
Telephone Number	:	626-922-9492
Fax Number	:

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	07/08/2007

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