MEDICARE: RAPHA ACUPUNCTURE & HERBAL CLINIC

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

General Provider Information

NPI Number	:	1124692140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAPHA ACUPUNCTURE & HERBAL CLINIC

Provider Business Mailing Address
First Line	:	9455 BALTIMORE NATIONAL PIKE STE B
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-2812
Country	:	US
Telephone Number	:	443-535-7575
Fax Number	:

Provider Business Practice Location Address
First Line	:	9455 BALTIMORE NATIONAL PIKE STE B
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-2812
Country	:	US
Telephone Number	:	443-535-7575
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. JUNG AH KIM
Credential	:	L.AC , OMD
Telephone Number	:	443-535-7575

Provider Enumeration Date	:	05/14/2021
Last Update Date	:	05/14/2021

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