MEDICARE: JIHWON IM

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	15600	CA

General Provider Information

NPI Number	:	1477046787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIHWON IM

Provider Business Mailing Address
First Line	:	415 S BERENDO ST APT 109
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-2165
Country	:	US
Telephone Number	:	213-804-0928
Fax Number	:

Provider Business Practice Location Address
First Line	:	4870 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2634
Country	:	US
Telephone Number	:	213-804-0928
Fax Number	:

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

Provider Enumeration Date	:	06/11/2018
Last Update Date	:	06/11/2018

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Directions to “ JIHWON IM ” Practice Location

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