MEDICARE: HYUNJEONG KOO 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	12995	CA

General Provider Information

NPI Number	:	1285968081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HYUNJEONG KOO L.AC.

Provider Business Mailing Address
First Line	:	3031 TISCH WAY STE 5PW
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-2530
Country	:	US
Telephone Number	:	408-260-8868
Fax Number	:	408-260-8889

Provider Business Practice Location Address
First Line	:	3031 TISCH WAY STE 5PW
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-2530
Country	:	US
Telephone Number	:	408-260-8868
Fax Number	:	408-260-8889

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

Provider Enumeration Date	:	09/25/2009
Last Update Date	:	09/25/2009

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