MEDICARE: TAE HEE KIM ACPUNCTURIST

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	AC15325	CA

General Provider Information

NPI Number	:	1710400296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAE HEE KIM ACPUNCTURIST

Provider Business Mailing Address
First Line	:	520 S VIRGIL AVE STE 503
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1452
Country	:	US
Telephone Number	:	323-677-4900
Fax Number	:	323-677-4904

Provider Business Practice Location Address
First Line	:	520 S VIRGIL AVE STE 503
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1452
Country	:	US
Telephone Number	:	323-677-4900
Fax Number	:	323-677-4904

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

Provider Enumeration Date	:	07/17/2017
Last Update Date	:	07/17/2017

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