MEDICARE: MRS. JUNG SOOK KIM 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	AC11255	CA

General Provider Information

NPI Number	:	1235320037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUNG SOOK KIM L.AC.

Provider Business Mailing Address
First Line	:	7230 MEDICAL CENTER DR STE 400
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91307-4013
Country	:	US
Telephone Number	:	818-251-1965
Fax Number	:	818-251-1969

Provider Business Practice Location Address
First Line	:	7230 MEDICAL CENTER DR STE 400
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91307-4013
Country	:	US
Telephone Number	:	818-251-1965
Fax Number	:	818-251-1969

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

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	08/06/2007

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