MEDICARE: MR. YUNSANG SONG 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	AC11527	CA

General Provider Information

NPI Number	:	1821274218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. YUNSANG SONG L.AC.

Provider Business Mailing Address
First Line	:	6242 BEACH BLVD
Second Line	:	UNIT B
City	:	BUENA PARK
State	:	CA
Zip	:	90621-2399
Country	:	US
Telephone Number	:	714-523-2780
Fax Number	:	714-523-2781

Provider Business Practice Location Address
First Line	:	6242 BEACH BLVD
Second Line	:	UNIT B
City	:	BUENA PARK
State	:	CA
Zip	:	90621-2399
Country	:	US
Telephone Number	:	714-523-2780
Fax Number	:	714-523-2781

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

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	01/15/2008

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