MEDICARE: YOUNG UK KIM LAC

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 11208	CA

General Provider Information

NPI Number	:	1417183765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOUNG UK KIM LAC

Provider Business Mailing Address
First Line	:	621 S . VIRGIL AVE
Second Line	:	#310
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-4047
Country	:	US
Telephone Number	:	213-382-5556
Fax Number	:	213-382-5575

Provider Business Practice Location Address
First Line	:	621 S VIRGIL AVE
Second Line	:	#310
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-4000
Country	:	US
Telephone Number	:	213-382-5556
Fax Number	:	213-382-5575

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

Provider Enumeration Date	:	06/01/2009
Last Update Date	:	12/19/2011

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Directions to “ YOUNG UK KIM LAC” Practice Location

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