MEDICARE: JAYNE KIM 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	AC9977	CA

General Provider Information

NPI Number	:	1841460342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYNE KIM L.AC.

Provider Business Mailing Address
First Line	:	1319 N LA BREA AVE
Second Line	:
City	:	HOLLYWOOD
State	:	CA
Zip	:	90028-7503
Country	:	US
Telephone Number	:	323-876-7708
Fax Number	:

Provider Business Practice Location Address
First Line	:	4017 WILSHIRE BLVD # A
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3401
Country	:	US
Telephone Number	:	132-284-1133
Fax Number	:

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

Provider Enumeration Date	:	03/11/2008
Last Update Date	:	10/09/2019

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Directions to “ JAYNE KIM L.AC.” Practice Location

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