MEDICARE: YISOOK 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

General Provider Information

NPI Number	:	1740815257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YISOOK KIM

Provider Business Mailing Address
First Line	:	57 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4804
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	57 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4804
Country	:	US
Telephone Number	:	310-913-7807
Fax Number	:

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

Provider Enumeration Date	:	03/04/2020
Last Update Date	:	03/04/2020

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Directions to “ YISOOK KIM ” Practice Location

Language	Start Address	Practice Location

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