MEDICARE: INSULWON ACUPUNCTURE INC

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	261Q00000X	Clinic/Center	AC9728	CA

General Provider Information

NPI Number	:	1952606386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSULWON ACUPUNCTURE INC

Provider Business Mailing Address
First Line	:	2104 CRENSHAW BLVD
Second Line	:	#101
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-1806
Country	:	US
Telephone Number	:	323-317-1725
Fax Number	:	323-732-8825

Provider Business Practice Location Address
First Line	:	2104 CRENSHAW BLVD
Second Line	:	#101
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-1806
Country	:	US
Telephone Number	:	323-317-1725
Fax Number	:	323-732-8825

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. SEONGHEE LO
Credential	:
Telephone Number	:	323-317-1725

Provider Enumeration Date	:	01/15/2011
Last Update Date	:	01/15/2011

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