MEDICARE: JIN SUK JUN 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	AC7084	CA

General Provider Information

NPI Number	:	1316125891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIN SUK JUN AC

Provider Business Mailing Address
First Line	:	2140 W OLYMPIC BLVD STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2277
Country	:	US
Telephone Number	:	213-480-1612
Fax Number	:	213-500-2580

Provider Business Practice Location Address
First Line	:	2140 W OLYMPIC BLVD STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2277
Country	:	US
Telephone Number	:	213-480-1612
Fax Number	:	213-500-2580

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

Provider Enumeration Date	:	02/06/2008
Last Update Date	:	02/06/2008

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