MEDICARE: WOORI MEDICAL CENTER CORP

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	207Q00000X	Family Medicine Physician	A42566	CA

General Provider Information

NPI Number	:	1992751945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOORI MEDICAL CENTER CORP

Provider Business Mailing Address
First Line	:	2655 W OLYMPIC BLVD
Second Line	:	SUITE 207
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2484
Country	:	US
Telephone Number	:	213-388-7887
Fax Number	:	213-388-3504

Provider Business Practice Location Address
First Line	:	2655 W OLYMPIC BLVD
Second Line	:	SUITE 207
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2484
Country	:	US
Telephone Number	:	213-388-7887
Fax Number	:	213-388-3504

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SEUNG R AN
Credential	:	MD
Telephone Number	:	213-388-7887

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	11/15/2013

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