MEDICARE: HYUN KIM

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	7419	CA

General Provider Information

NPI Number	:	1598184749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HYUN KIM

Provider Business Mailing Address
First Line	:	3243 FAIRESTA ST APT 3
Second Line	:
City	:	LA CRESCENTA
State	:	CA
Zip	:	91214-2616
Country	:	US
Telephone Number	:	714-791-9307
Fax Number	:

Provider Business Practice Location Address
First Line	:	3407 W 6TH ST
Second Line	:	#827
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-2537
Country	:	US
Telephone Number	:	714-791-9307
Fax Number	:

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

Provider Enumeration Date	:	04/15/2014
Last Update Date	:	04/15/2014

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Directions to “ HYUN KIM ” Practice Location

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