MEDICARE: YONG LAN KIM

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	AC13922	CA

General Provider Information

NPI Number	:	1982095766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YONG LAN KIM

Provider Business Mailing Address
First Line	:	3044 W 7TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1452
Country	:	US
Telephone Number	:	213-235-8768
Fax Number	:

Provider Business Practice Location Address
First Line	:	3044 W 7TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1452
Country	:	US
Telephone Number	:	213-235-8768
Fax Number	:

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

Provider Enumeration Date	:	02/14/2015
Last Update Date	:	02/14/2015

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Directions to “ YONG LAN KIM ” Practice Location

Language	Start Address	Practice Location

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