MEDICARE: LEONA KIMI MARRS M.S., 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	12790	CA

General Provider Information

NPI Number	:	1477868495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONA KIMI MARRS M.S., L.AC.

Provider Business Mailing Address
First Line	:	3127 GLENDALE BLVD STE B
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1857
Country	:	US
Telephone Number	:	206-383-6746
Fax Number	:

Provider Business Practice Location Address
First Line	:	2820 GLENDALE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-2723
Country	:	US
Telephone Number	:	206-383-6746
Fax Number	:

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

Provider Enumeration Date	:	08/13/2010
Last Update Date	:	08/13/2010

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