MEDICARE: KOUNG BAEK DACM

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	AC60512130	WA

General Provider Information

NPI Number	:	1932504420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KOUNG BAEK DACM

Provider Business Mailing Address
First Line	:	20210 77TH AVE NE
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-4602
Country	:	US
Telephone Number	:	360-322-7221
Fax Number	:	360-386-8867

Provider Business Practice Location Address
First Line	:	20210 77TH AVE NE
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-4602
Country	:	US
Telephone Number	:	360-322-7221
Fax Number	:	360-386-8867

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

Provider Enumeration Date	:	10/27/2014
Last Update Date	:	12/21/2023

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