MEDICARE: INSULWON ACUPUNCTURE INC.

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	AC9728	CA

General Provider Information

NPI Number	:	1558615245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSULWON ACUPUNCTURE INC.

Provider Business Mailing Address
First Line	:	1716 CRENSHAW BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-6036
Country	:	US
Telephone Number	:	323-732-8825
Fax Number	:	323-732-8825

Provider Business Practice Location Address
First Line	:	1716 CRENSHAW BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-6036
Country	:	US
Telephone Number	:	323-317-1725
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT / CEO
Name	:	DR. BYOUNG SIK KIM
Credential	:	PH D., DAOM, LAC.
Telephone Number	:	323-317-1725

Provider Enumeration Date	:	11/01/2012
Last Update Date	:	12/24/2012

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