MEDICARE: YONG MUN KIM LAC

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	AC7461	CA

General Provider Information

NPI Number	:	1952578023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YONG MUN KIM LAC

Provider Business Mailing Address
First Line	:	2520 W 8TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3861
Country	:	US
Telephone Number	:	213-736-5575
Fax Number	:	213-736-5585

Provider Business Practice Location Address
First Line	:	2520 W 8TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3861
Country	:	US
Telephone Number	:	213-736-5575
Fax Number	:	213-736-5585

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

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	05/08/2008

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