MEDICARE: DR. JAE-KWON 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	1394	CO

General Provider Information

NPI Number	:	1497077747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAE-KWON KIM PH.D.

Provider Business Mailing Address
First Line	:	5145 N ACADEMY BLVD
Second Line	:	STE#100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4049
Country	:	US
Telephone Number	:	719-266-0577
Fax Number	:

Provider Business Practice Location Address
First Line	:	5145 N ACADEMY BLVD
Second Line	:	STE#100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4049
Country	:	US
Telephone Number	:	719-266-0577
Fax Number	:

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

Provider Enumeration Date	:	02/26/2010
Last Update Date	:	02/26/2010

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