MEDICARE: YOUNG TEK 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	18713	CA

General Provider Information

NPI Number	:	1922642172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOUNG TEK KIM L.AC

Provider Business Mailing Address
First Line	:	945 S WESTERN AVE STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-1008
Country	:	US
Telephone Number	:	818-636-4261
Fax Number	:

Provider Business Practice Location Address
First Line	:	945 S WESTERN AVE STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-1008
Country	:	US
Telephone Number	:	818-636-4261
Fax Number	:

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

Provider Enumeration Date	:	10/31/2019
Last Update Date	:	10/31/2019

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Directions to “ YOUNG TEK KIM L.AC” Practice Location

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