MEDICARE: IN KI PARK 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	10003	CA

General Provider Information

NPI Number	:	1972744845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IN KI PARK LAC

Provider Business Mailing Address
First Line	:	269 S. LA FAYETTE PARK PL STE 449
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057
Country	:	US
Telephone Number	:	213-604-0081
Fax Number	:	714-522-8775

Provider Business Practice Location Address
First Line	:	269 S LA FAYETTE PARK PL APT 449
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-1378
Country	:	US
Telephone Number	:	213-604-0081
Fax Number	:	714-522-8775

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

Provider Enumeration Date	:	03/23/2009
Last Update Date	:	03/23/2009

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Directions to “ IN KI PARK LAC” Practice Location

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