MEDICARE: MANHAE

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	01600036001	IL

General Provider Information

NPI Number	:	1326368499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANHAE

Provider Business Mailing Address
First Line	:	342 E GOLF RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-4008
Country	:	US
Telephone Number	:	847-427-5678
Fax Number	:

Provider Business Practice Location Address
First Line	:	342 E GOLF RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-4008
Country	:	US
Telephone Number	:	847-427-5678
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. SUNG IL KIM
Credential	:	ACUPUNCTURIST
Telephone Number	:	17087173351

Provider Enumeration Date	:	06/10/2010
Last Update Date	:	06/10/2010

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Directions to “MANHAE ” Practice Location

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