MEDICARE: GLORIA EUNSOOK LEE ACUPUNCTURE

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	AC11084	CA

General Provider Information

NPI Number	:	1639297153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA EUNSOOK LEE ACUPUNCTURE

Provider Business Mailing Address
First Line	:	520 S VIRGIL AVE STE 305
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1425
Country	:	US
Telephone Number	:	213-389-8275
Fax Number	:	213-736-5189

Provider Business Practice Location Address
First Line	:	520 S VIRGIL AVE STE 305
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1425
Country	:	US
Telephone Number	:	213-389-8275
Fax Number	:	213-736-5189

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	04/24/2015

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Directions to “ GLORIA EUNSOOK LEE ACUPUNCTURE” Practice Location

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