MEDICARE: YM ACUPUNCTURE 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1629566591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YM ACUPUNCTURE INC

Provider Business Mailing Address
First Line	:	3959 LAUREL CANYON BLVD STE A
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-3711
Country	:	US
Telephone Number	:	818-980-7979
Fax Number	:	818-980-7980

Provider Business Practice Location Address
First Line	:	3959 LAUREL CANYON BLVD STE A
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-3711
Country	:	US
Telephone Number	:	818-980-7979
Fax Number	:	818-980-7980

Authorized Official
Title or Position	:	ACUPUNCTURIST
Name	:	CHANG WOO KO
Credential	:
Telephone Number	:	818-980-7979

Provider Enumeration Date	:	04/26/2018
Last Update Date	:	04/26/2018

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