MEDICARE: MR. DANIEL ICHIRO KIYAMA 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	AC10178	CA

General Provider Information

NPI Number	:	1932320207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL ICHIRO KIYAMA L.AC

Provider Business Mailing Address
First Line	:	111 CLOUDCREST
Second Line	:
City	:	ALISO VIEJO
State	:	CA
Zip	:	92656-1323
Country	:	US
Telephone Number	:	949-683-2817
Fax Number	:

Provider Business Practice Location Address
First Line	:	15541 BEACH BLVD
Second Line	:	SUITE B
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-7104
Country	:	US
Telephone Number	:	949-683-2817
Fax Number	:

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/08/2007

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