MEDICARE: DR. SARAH KIM LAC OMD

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	AC10029	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CA0100290	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1134224447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARAH KIM LAC OMD

Provider Business Mailing Address
First Line	:	18411 CRENSHAW BLVD # 385
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90504-5042
Country	:	US
Telephone Number	:	310-266-9760
Fax Number	:	310-756-6159

Provider Business Practice Location Address
First Line	:	18411 CRENSHAW BLVD # 385
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90504-5042
Country	:	US
Telephone Number	:	310-266-9760
Fax Number	:	310-756-6159

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	06/07/2023

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