MEDICARE: WON MI KIM 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	AC10708	CA

General Provider Information

NPI Number	:	1568524452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WON MI KIM L.AC.

Provider Business Mailing Address
First Line	:	536 N SWEETZER AVE
Second Line	:	8
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-2652
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	536 N SWEETZER AVE
Second Line	:	8
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-2652
Country	:	US
Telephone Number	:	310-400-4473
Fax Number	:

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	11/05/2015

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Directions to “ WON MI KIM L.AC.” Practice Location

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