MEDICARE: YURI OVCHINNIKOV 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	AC6960	CA

General Provider Information

NPI Number	:	1366482762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YURI OVCHINNIKOV L.AC

Provider Business Mailing Address
First Line	:	1 EARHART
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92620-3335
Country	:	US
Telephone Number	:	323-428-9846
Fax Number	:

Provider Business Practice Location Address
First Line	:	8205 SANTA MONICA BLVD
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5963
Country	:	US
Telephone Number	:	323-656-5115
Fax Number	:

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	07/09/2007

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