MEDICARE: DAE SANG ACUPUNCTURE CLINIC, INC.

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	9471	CA

General Provider Information

NPI Number	:	1003122631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAE SANG ACUPUNCTURE CLINIC, INC.

Provider Business Mailing Address
First Line	:	33 CREEK RD STE 270
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92604-7707
Country	:	US
Telephone Number	:	949-769-3384
Fax Number	:	949-608-1924

Provider Business Practice Location Address
First Line	:	33 CREEK RD STE 270
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92604-7707
Country	:	US
Telephone Number	:	949-769-3384
Fax Number	:	949-608-1924

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES SHIN
Credential	:	LAC, PHD
Telephone Number	:	949-769-3384

Provider Enumeration Date	:	08/20/2010
Last Update Date	:	08/20/2010

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