MEDICARE: MINSUK 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	AC9465	CA
2	171100000X	Acupuncturist	2039	NC

General Provider Information

NPI Number	:	1447445598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINSUK KIM L.AC.

Provider Business Mailing Address
First Line	:	11121 VALLEY SPRING DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-3730
Country	:	US
Telephone Number	:	704-228-1311
Fax Number	:	980-422-0489

Provider Business Practice Location Address
First Line	:	7810 BALLANTYNE COMMONS PKWY STE 225
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-3416
Country	:	US
Telephone Number	:	310-975-9129
Fax Number	:	980-422-0489

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

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	06/05/2023

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Directions to “ MINSUK KIM L.AC.” Practice Location

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