MEDICARE: YOUNA 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	AC12685	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AC12685	OTHER	CA	ACUPUNCTURE

General Provider Information

NPI Number	:	1619402674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOUNA KIM

Provider Business Mailing Address
First Line	:	14764 BEACH BLVD
Second Line	:
City	:	LA MIRADA
State	:	CA
Zip	:	90638-4250
Country	:	US
Telephone Number	:	714-392-9968
Fax Number	:	310-638-8549

Provider Business Practice Location Address
First Line	:	14764 BEACH BLVD
Second Line	:
City	:	LA MIRADA
State	:	CA
Zip	:	90638-4250
Country	:	US
Telephone Number	:	714-392-9968
Fax Number	:	310-638-8549

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

Provider Enumeration Date	:	04/27/2017
Last Update Date	:	04/27/2017

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Directions to “ YOUNA KIM ” Practice Location

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