MEDICARE: MRS. YOOSOON KIM LAC

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	AC7803	CA

General Provider Information

NPI Number	:	1548390073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YOOSOON KIM LAC

Provider Business Mailing Address
First Line	:	5527 BURNING TREE DR
Second Line	:
City	:	LA CANADA
State	:	CA
Zip	:	91011-2860
Country	:	US
Telephone Number	:	818-952-5075
Fax Number	:	323-933-8815

Provider Business Practice Location Address
First Line	:	4160 WILSHIRE BLVD
Second Line	:	SUITE NO 301
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3569
Country	:	US
Telephone Number	:	323-933-8814
Fax Number	:	323-933-8815

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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