MEDICARE: BETHEL LIGHT CORPORATION

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	AC 9139	CA

General Provider Information

NPI Number	:	1346414844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHEL LIGHT CORPORATION

Provider Business Mailing Address
First Line	:	408 S BEACH BLVD STE 110
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-1864
Country	:	US
Telephone Number	:	714-821-4823
Fax Number	:	714-821-4825

Provider Business Practice Location Address
First Line	:	408 S BEACH BLVD STE 110
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-1864
Country	:	US
Telephone Number	:	714-821-4823
Fax Number	:	714-821-4825

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JUNGHOON PAIK
Credential	:	ACUPUNCTURIST
Telephone Number	:	714-821-4823

Provider Enumeration Date	:	04/15/2008
Last Update Date	:	04/15/2008

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