MEDICARE: YOUNG WOO NAM 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	AC12181	CA

General Provider Information

NPI Number	:	1467601435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOUNG WOO NAM AC

Provider Business Mailing Address
First Line	:	1247 S CATALINA ST # E
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-3305
Country	:	US
Telephone Number	:	213-703-5558
Fax Number	:	213-365-1206

Provider Business Practice Location Address
First Line	:	1247 S CATALINA ST # E
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-3305
Country	:	US
Telephone Number	:	213-703-5558
Fax Number	:	213-365-1206

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

Provider Enumeration Date	:	09/15/2008
Last Update Date	:	09/15/2008

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