MEDICARE: EMILL C KIM O.M.D. 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	AC9731	CA

General Provider Information

NPI Number	:	1801967070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILL C KIM O.M.D. L.AC

Provider Business Mailing Address
First Line	:	500 EATON DR
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-2856
Country	:	US
Telephone Number	:	626-796-6050
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 E COLORADO BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3545
Country	:	US
Telephone Number	:	626-796-1916
Fax Number	:

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

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	07/08/2007

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