MEDICARE: BIJOU SKINCARE & 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	AC 12339	CA

General Provider Information

NPI Number	:	1720422256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIJOU SKINCARE & ACUPUNCTURE

Provider Business Mailing Address
First Line	:	1401 S BEACH BLVD
Second Line	:	SUITE G1
City	:	LA HABRA
State	:	CA
Zip	:	90631-6377
Country	:	US
Telephone Number	:	562-943-1234
Fax Number	:	562-943-3000

Provider Business Practice Location Address
First Line	:	1401 S BEACH BLVD
Second Line	:	SUITE G1
City	:	LA HABRA
State	:	CA
Zip	:	90631-6377
Country	:	US
Telephone Number	:	562-943-1234
Fax Number	:	562-943-3000

Authorized Official
Title or Position	:	L.AC. / PRESIDENT
Name	:	YUNJA PARK
Credential	:
Telephone Number	:	562-943-1234

Provider Enumeration Date	:	04/26/2013
Last Update Date	:	04/26/2013

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