MEDICARE: DR. KEVIN YUNSANG KIM 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	377	NC
2	171100000X	Acupuncturist	AC 11172	CA

General Provider Information

NPI Number	:	1396942058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN YUNSANG KIM L.AC.

Provider Business Mailing Address
First Line	:	8033 CORPORATE CENTER DR STE 400
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4549
Country	:	US
Telephone Number	:	704-540-7471
Fax Number	:	704-540-7472

Provider Business Practice Location Address
First Line	:	8033 CORPORATE CENTER DR STE 400
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4549
Country	:	US
Telephone Number	:	704-540-7471
Fax Number	:	704-540-7472

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

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	01/22/2010

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