MEDICARE: ICK YOUL EOM

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	AC16283	CA

General Provider Information

NPI Number	:	1528444668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ICK YOUL EOM

Provider Business Mailing Address
First Line	:	369 N FAIRFAX AVE STE 2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-2175
Country	:	US
Telephone Number	:	323-963-5027
Fax Number	:	323-499-1274

Provider Business Practice Location Address
First Line	:	369 N FAIRFAX AVE STE 2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-2175
Country	:	US
Telephone Number	:	323-963-5027
Fax Number	:	323-499-1274

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

Provider Enumeration Date	:	07/30/2015
Last Update Date	:	06/24/2026

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Directions to “ ICK YOUL EOM ” Practice Location

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