MEDICARE: MR. ISSAC KIM LAC

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	AC11862	CA

General Provider Information

NPI Number	:	1659555068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ISSAC KIM LAC

Provider Business Mailing Address
First Line	:	756 S KINGSLEY DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2120 W 8TH ST STE 210
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-4081
Country	:	US
Telephone Number	:	213-386-4517
Fax Number	:	213-386-0021

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

Provider Enumeration Date	:	12/20/2007
Last Update Date	:	03/12/2018

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