MEDICARE: ELEANOR S 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	9543	CA

General Provider Information

NPI Number	:	1265578959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEANOR S KIM L.AC.

Provider Business Mailing Address
First Line	:	1440 N HARBOR BLVD
Second Line	:	114
City	:	FULLERTON
State	:	CA
Zip	:	92835-4127
Country	:	US
Telephone Number	:	714-870-9999
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 N HARBOR BLVD
Second Line	:	114
City	:	FULLERTON
State	:	CA
Zip	:	92835-4127
Country	:	US
Telephone Number	:	714-870-9999
Fax Number	:

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	09/12/2007

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