MEDICARE: JEONG SIK SHIN L.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	AC12099	CA

General Provider Information

NPI Number	:	1154644581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEONG SIK SHIN L.AC.

Provider Business Mailing Address
First Line	:	809 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1522
Country	:	US
Telephone Number	:	213-739-0855
Fax Number	:	213-739-0838

Provider Business Practice Location Address
First Line	:	809 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1522
Country	:	US
Telephone Number	:	213-739-0855
Fax Number	:	213-739-0838

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

Provider Enumeration Date	:	03/12/2010
Last Update Date	:	03/12/2010

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Directions to “ JEONG SIK SHIN L.AC.” Practice Location

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