MEDICARE: YEONJUNG 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	AC11272	CA

General Provider Information

NPI Number	:	1710259726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YEONJUNG KIM

Provider Business Mailing Address
First Line	:	6220 MORELLA AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3412
Country	:	US
Telephone Number	:	213-700-8542
Fax Number	:

Provider Business Practice Location Address
First Line	:	6220 MORELLA AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606
Country	:	US
Telephone Number	:	213-700-8542
Fax Number	:

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

Provider Enumeration Date	:	02/07/2012
Last Update Date	:	02/07/2012

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Directions to “ YEONJUNG KIM ” Practice Location

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