MEDICARE: IN JOON CHUNG LAC, OMD

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	AC11529	CA

General Provider Information

NPI Number	:	1417194663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IN JOON CHUNG LAC, OMD

Provider Business Mailing Address
First Line	:	903 CRENSHAW BLVD STE 302
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-1967
Country	:	US
Telephone Number	:	323-938-1000
Fax Number	:	323-938-6642

Provider Business Practice Location Address
First Line	:	903 CRENSHAW BLVD STE 302
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-1967
Country	:	US
Telephone Number	:	323-938-1000
Fax Number	:	323-938-6642

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

Provider Enumeration Date	:	01/09/2009
Last Update Date	:	01/09/2009

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