MEDICARE: MISS JAEEUN JUNG LAC

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	11638	CA

General Provider Information

NPI Number	:	1164615266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JAEEUN JUNG LAC

Provider Business Mailing Address
First Line	:	827 DEEP VALLEY DR STE 207
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-3654
Country	:	US
Telephone Number	:	310-541-7999
Fax Number	:	310-544-1969

Provider Business Practice Location Address
First Line	:	827 DEEP VALLEY DR STE 207
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-3654
Country	:	US
Telephone Number	:	310-541-7999
Fax Number	:	310-544-1969

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

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	08/22/2007

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