MEDICARE: JAEYOUNG KIM L. AC

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	16469	CA

General Provider Information

NPI Number	:	1811376668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAEYOUNG KIM L. AC

Provider Business Mailing Address
First Line	:	2316 ARTESIA BLVD
Second Line	:	SUITE E
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-3187
Country	:	US
Telephone Number	:	425-412-0468
Fax Number	:

Provider Business Practice Location Address
First Line	:	2316 ARTESIA BLVD
Second Line	:	SUITE E
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-3187
Country	:	US
Telephone Number	:	425-412-0468
Fax Number	:

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

Provider Enumeration Date	:	05/27/2015
Last Update Date	:	05/27/2015

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