MEDICARE: Q BIO ACUPUNCTURE CLINIC INC.

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	:	1205392180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	Q BIO ACUPUNCTURE CLINIC INC.

Provider Business Mailing Address
First Line	:	680 WILSHIRE PL STE 312
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-3950
Country	:	US
Telephone Number	:	213-386-2345
Fax Number	:	213-386-2347

Provider Business Practice Location Address
First Line	:	680 WILSHIRE PL STE 312
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-3950
Country	:	US
Telephone Number	:	213-386-2345
Fax Number	:	213-386-2347

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUNKYEOM KIM
Credential	:	L.AC
Telephone Number	:	213-386-2345

Provider Enumeration Date	:	02/14/2019
Last Update Date	:	02/14/2019

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