MEDICARE: DR. JONG HO KIM AC

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	AC5785	CA

General Provider Information

NPI Number	:	1063623494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONG HO KIM AC

Provider Business Mailing Address
First Line	:	2140 W OLYMPIC BLVD STE 308
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2279
Country	:	US
Telephone Number	:	213-383-5313
Fax Number	:	213-383-5356

Provider Business Practice Location Address
First Line	:	2140 W OLYMPIC BLVD STE 308
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2279
Country	:	US
Telephone Number	:	213-383-5313
Fax Number	:	213-383-5356

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

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. JONG HO KIM AC” Practice Location

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