MEDICARE: MR. HYUN JIN KO L.AC.

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	AC8432	CA

General Provider Information

NPI Number	:	1700949799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HYUN JIN KO L.AC.

Provider Business Mailing Address
First Line	:	16202 EAGLERIDGE CT
Second Line	:
City	:	LA MIRADA
State	:	CA
Zip	:	90638-6505
Country	:	US
Telephone Number	:	714-402-2054
Fax Number	:

Provider Business Practice Location Address
First Line	:	9535 GARDEN GROVE BLVD STE 103
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92844-1551
Country	:	US
Telephone Number	:	714-534-1113
Fax Number	:	714-534-1116

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/08/2007

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