MEDICARE: MRS. HYUCK HEE TANA KWON 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	AC18580	CA

General Provider Information

NPI Number	:	1902444235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HYUCK HEE TANA KWON L.AC

Provider Business Mailing Address
First Line	:	12792 VALLEY VIEW ST STE C
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-2509
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12792 VALLEY VIEW ST STE C
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-2509
Country	:	US
Telephone Number	:	714-898-2580
Fax Number	:

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

Provider Enumeration Date	:	12/17/2019
Last Update Date	:	12/17/2019

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