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General NPI Number Information
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NPI Number | 1598117566
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Entity Type | Organization
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Legal Business Name | MIRACLE PAINCARE ACUPUNCTURE INC
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Dates
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Enumeration Date | 07/01/2016
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Last Update Date | 07/01/2016
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Provider Practice Location Address
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Address Line | 15508 S NORMANDIE AVE
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City | GARDENA
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State | CA
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Zip | 90247-4014
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Country | US
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Telephone | 310-523-3747
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Fax | 310-323-6470
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Provider Business Mailing Address
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Address Line | 15508 S NORMANDIE AVE
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City | GARDENA
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State | CA
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Zip | 90247-4014
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Country | US
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Telephone | 310-523-3747
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Fax | 310-323-6470
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Authorized Official
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Title or Position | OWNER
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Name | DR. YOUNG H KIM
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Credential |
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Telephone | 714-392-0104
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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 | AC6544
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License Number State | CA
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