Healthcare Provider Details

I. General information

NPI: 1548917131
Provider Name (Legal Business Name): COURTNEY KIMBERLEY MUNCH L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 03/03/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 WILSHIRE BLVD STE 850
BEVERLY HILLS CA
90212-3467
US

IV. Provider business mailing address

9100 WILSHIRE BLVD STE 850
BEVERLY HILLS CA
90212-3467
US

V. Phone/Fax

Practice location:
  • Phone: 310-550-0299
  • Fax:
Mailing address:
  • Phone: 310-550-0299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: