MEDICARE: JOAN KIM-WAGNER 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	AC9278	CA

General Provider Information

NPI Number	:	1922207448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN KIM-WAGNER AC

Provider Business Mailing Address
First Line	:	2254 HIDALGO AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-3632
Country	:	US
Telephone Number	:	323-244-1985
Fax Number	:	323-913-0714

Provider Business Practice Location Address
First Line	:	1501 COLORADO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-1424
Country	:	US
Telephone Number	:	323-244-1985
Fax Number	:	323-913-0714

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

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	07/13/2007

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Directions to “ JOAN KIM-WAGNER AC” Practice Location

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