MEDICARE: MS. MAGIE SONG 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	AC 12473	CA

General Provider Information

NPI Number	:	1215102413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAGIE SONG L.AC

Provider Business Mailing Address
First Line	:	6230 WILSHIRE BLVD
Second Line	:	SUITE 1142
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5104
Country	:	US
Telephone Number	:	323-769-5773
Fax Number	:

Provider Business Practice Location Address
First Line	:	6230 WILSHIRE BLVD
Second Line	:	SUITE 1142
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5104
Country	:	US
Telephone Number	:	323-769-5773
Fax Number	:

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

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	05/05/2008

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