MEDICARE: KYOUNG JOO NA

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	18300	CA

General Provider Information

NPI Number	:	1851919864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYOUNG JOO NA

Provider Business Mailing Address
First Line	:	910 S GRAMERCY PL APT 107
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-2193
Country	:	US
Telephone Number	:	602-882-8606
Fax Number	:

Provider Business Practice Location Address
First Line	:	3460 W OLYMPIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-2124
Country	:	US
Telephone Number	:	323-733-8814
Fax Number	:

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

Provider Enumeration Date	:	07/07/2020
Last Update Date	:	07/07/2020

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Directions to “ KYOUNG JOO NA ” Practice Location

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