MEDICARE: YONG SEOP KIM

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	AC 11731	CA

General Provider Information

NPI Number	:	1629528690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YONG SEOP KIM

Provider Business Mailing Address
First Line	:	3545 WILSHIRE BLVD STE 327
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2388
Country	:	US
Telephone Number	:	213-819-9199
Fax Number	:

Provider Business Practice Location Address
First Line	:	3545 WILSHIRE BLVD STE 327
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2388
Country	:	US
Telephone Number	:	213-819-9199
Fax Number	:

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

Provider Enumeration Date	:	10/13/2016
Last Update Date	:	10/13/2016

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Directions to “ YONG SEOP KIM ” Practice Location

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