MEDICARE: MIRA SHIN 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	AC8701	CA

General Provider Information

NPI Number	:	1518191519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRA SHIN L.AC.

Provider Business Mailing Address
First Line	:	1245 WILSHIRE BLVD STE 403
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4804
Country	:	US
Telephone Number	:	213-482-1046
Fax Number	:	213-482-4811

Provider Business Practice Location Address
First Line	:	1245 WILSHIRE BLVD STE 403
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4804
Country	:	US
Telephone Number	:	213-482-1046
Fax Number	:	213-482-4811

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

Provider Enumeration Date	:	05/06/2009
Last Update Date	:	05/06/2009

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Directions to “ MIRA SHIN L.AC.” Practice Location

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