MEDICARE: DR. MOON RENG LEE 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	AC13397	CA

General Provider Information

NPI Number	:	1942756663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOON RENG LEE KIM L.AC.

Provider Business Mailing Address
First Line	:	5327 HARVEST RUN DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-4877
Country	:	US
Telephone Number	:	858-945-0068
Fax Number	:

Provider Business Practice Location Address
First Line	:	8303 CLAIREMONT MESA BLVD
Second Line	:	#104
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-1326
Country	:	US
Telephone Number	:	858-866-6081
Fax Number	:

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

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	09/01/2016

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