MEDICARE: SONGHYUN 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	19461	CA

General Provider Information

NPI Number	:	1407593064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONGHYUN KIM L.AC

Provider Business Mailing Address
First Line	:	351 S FULLER AVE APT 4B
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-5459
Country	:	US
Telephone Number	:	808-428-6828
Fax Number	:

Provider Business Practice Location Address
First Line	:	338 N WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-2602
Country	:	US
Telephone Number	:	213-250-5106
Fax Number	:	213-250-8861

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

Provider Enumeration Date	:	05/16/2022
Last Update Date	:	01/15/2026

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