MEDICARE: A&C WELLPOINT INC

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
2	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1538832258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A&C WELLPOINT INC

Provider Business Mailing Address
First Line	:	PO BOX 2895
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-1095
Country	:	US
Telephone Number	:	310-532-8008
Fax Number	:	213-388-7941

Provider Business Practice Location Address
First Line	:	3407 W 6TH ST STE 617
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-2553
Country	:	US
Telephone Number	:	310-532-8008
Fax Number	:	213-388-7941

Authorized Official
Title or Position	:	ACUPUNCTURIST
Name	:	MI OK KIM
Credential	:	L.AC
Telephone Number	:	310-532-8008

Provider Enumeration Date	:	07/28/2021
Last Update Date	:	07/28/2021

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Directions to “A&C WELLPOINT INC ” Practice Location

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