MEDICARE: JASMINE HERB AND ACUPUNCTURE, 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	AC10209	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AC10209	OTHER	CA	ACUPUNCTURE

General Provider Information

NPI Number	:	1225362239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASMINE HERB AND ACUPUNCTURE, INC.

Provider Business Mailing Address
First Line	:	3545 WILSHIRE BL.
Second Line	:	#337
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2388
Country	:	US
Telephone Number	:	213-382-0577
Fax Number	:	213-382-0551

Provider Business Practice Location Address
First Line	:	3545 WILSHIRE BL.
Second Line	:	#337
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2388
Country	:	US
Telephone Number	:	213-382-0577
Fax Number	:	213-382-0551

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAE CHANG PARK
Credential	:	LAC
Telephone Number	:	213-382-0577

Provider Enumeration Date	:	09/23/2009
Last Update Date	:	09/23/2009

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