MEDICARE: MR. KYO CHAN MUN 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	16391	CA

General Provider Information

NPI Number	:	1184003204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KYO CHAN MUN L.AC

Provider Business Mailing Address
First Line	:	238 AMETHYST CIR
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90248-3376
Country	:	US
Telephone Number	:	714-362-7344
Fax Number	:

Provider Business Practice Location Address
First Line	:	421 N BROOKHURST ST STE 119
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92801-5618
Country	:	US
Telephone Number	:	714-533-8575
Fax Number	:

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

Provider Enumeration Date	:	05/21/2015
Last Update Date	:	05/21/2015

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