MEDICARE: YUSUKE MORI 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	13985	CA

General Provider Information

NPI Number	:	1437468519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUSUKE MORI L.AC

Provider Business Mailing Address
First Line	:	3605 W HIDDEN LN
Second Line	:	#121
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-4155
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	36 MALAGA COVE PLZ
Second Line	:	SUITE203
City	:	PALOS VERDES ESTATES
State	:	CA
Zip	:	90274-6811
Country	:	US
Telephone Number	:	310-791-0437
Fax Number	:

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

Provider Enumeration Date	:	10/06/2010
Last Update Date	:	10/06/2010

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