MEDICARE: MS. KYUNG KIM LAC

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	AC14723	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932446325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KYUNG KIM LAC

Provider Business Mailing Address
First Line	:	2772 SEPULVEDA BLVD
Second Line	:	SUIT #28
City	:	TORRANCE
State	:	CA
Zip	:	90505-2952
Country	:	US
Telephone Number	:	310-220-4314
Fax Number	:

Provider Business Practice Location Address
First Line	:	2772 SEPULVEDA BLVD
Second Line	:	SUIT #28
City	:	TORRANCE
State	:	CA
Zip	:	90505-2952
Country	:	US
Telephone Number	:	310-220-4314
Fax Number	:

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

Provider Enumeration Date	:	01/07/2013
Last Update Date	:	01/07/2013

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