MEDICARE: HEALTHY LIFE ACUPUNCTURE CENTER

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	AC8229	CA

General Provider Information

NPI Number	:	1396983250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY LIFE ACUPUNCTURE CENTER

Provider Business Mailing Address
First Line	:	1241 S SOTO ST STE 110
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-2666
Country	:	US
Telephone Number	:	323-264-3288
Fax Number	:	323-264-0288

Provider Business Practice Location Address
First Line	:	1241 S SOTO ST STE 110
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-2666
Country	:	US
Telephone Number	:	323-264-3288
Fax Number	:	323-264-0288

Authorized Official
Title or Position	:	ACUPUNCTURIST
Name	:	MRS. KIMI XIAO GUDMUNSEN
Credential	:	L.AC.,O.M.D., PH.D
Telephone Number	:	323-264-3288

Provider Enumeration Date	:	01/30/2009
Last Update Date	:	01/30/2009

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