MEDICARE: DR. JEONG UN KIM PH. D.

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	AC 9090	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6134936	OTHER	CA	MEDICAL PIN

General Provider Information

NPI Number	:	1447383401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEONG UN KIM PH. D.

Provider Business Mailing Address
First Line	:	535 S ALEXANDRIA AVE
Second Line	:	APT 225
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-2860
Country	:	US
Telephone Number	:	213-389-3153
Fax Number	:	213-389-3153

Provider Business Practice Location Address
First Line	:	545 S ALVARADO ST
Second Line	:	#B
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2903
Country	:	US
Telephone Number	:	213-483-5447
Fax Number	:

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/08/2007

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