MEDICARE: JONG KAP KIM L.AC, PH.D

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	AC8493	CA

General Provider Information

NPI Number	:	1841329075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONG KAP KIM L.AC, PH.D

Provider Business Mailing Address
First Line	:	6431 LOS ROBLES AVE APT 1
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90621-3048
Country	:	US
Telephone Number	:	714-262-1516
Fax Number	:

Provider Business Practice Location Address
First Line	:	6431 LOS ROBLES AVE APT 1
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90621-3048
Country	:	US
Telephone Number	:	714-262-1516
Fax Number	:

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/08/2007

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