MEDICARE: SEON TAE 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	15786	CA

General Provider Information

NPI Number	:	1649601402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEON TAE KIM

Provider Business Mailing Address
First Line	:	2601 S BALDWIN AVE APT B
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91007-8356
Country	:	US
Telephone Number	:	213-427-7600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2727 W OLYMPIC BLVD STE 208
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2640
Country	:	US
Telephone Number	:	213-427-7600
Fax Number	:

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

Provider Enumeration Date	:	12/04/2013
Last Update Date	:	12/04/2013

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Directions to “ SEON TAE KIM ” Practice Location

Language	Start Address	Practice Location

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