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General NPI Number Information
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NPI Number | 1003454612
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Entity Type | Individual
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Provider Name | EARNKYUNG SHIN DAOM, L.AC.
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Gender | Female
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Dates
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Enumeration Date | 12/13/2019
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Last Update Date | 02/04/2020
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Provider Practice Location Address
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Address Line | 1700 WESTWOOD BLVD STE H
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City | LOS ANGELES
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State | CA
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Zip | 90024-5608
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Country | US
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Telephone | 805-262-7855
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Fax |
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Provider Business Mailing Address
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Address Line | 3185 WILSHIRE BLVD UNIT 461
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City | LOS ANGELES
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State | CA
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Zip | 90010-1243
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Country | US
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Telephone | 805-262-7855
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 17823
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License Number State | CA
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