MEDICARE: DR. WON 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	LAC. 1364	CA

General Provider Information

NPI Number	:	1528129889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WON KIM LAC.

Provider Business Mailing Address
First Line	:	3240 WILSHIRE BLVD
Second Line	:	SUITE # 290
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-1502
Country	:	US
Telephone Number	:	213-382-0052
Fax Number	:	213-382-5122

Provider Business Practice Location Address
First Line	:	3240 WILSHIRE BLVD
Second Line	:	SUITE # 290
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-1502
Country	:	US
Telephone Number	:	213-382-0052
Fax Number	:	213-382-5122

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. WON KIM LAC.” Practice Location

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