MEDICARE: AUDREY BENA KIM L.A.C

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	AC11914	CA

General Provider Information

NPI Number	:	1639305006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY BENA KIM L.A.C

Provider Business Mailing Address
First Line	:	15140 VENTURA BLVD
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-3343
Country	:	US
Telephone Number	:	818-386-0983
Fax Number	:	818-386-0984

Provider Business Practice Location Address
First Line	:	15140 VENTURA BLVD
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-3343
Country	:	US
Telephone Number	:	818-386-0983
Fax Number	:	818-386-0984

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

Provider Enumeration Date	:	05/29/2009
Last Update Date	:	05/29/2009

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