Healthcare Provider Details

I. General information

NPI: 1043801533
Provider Name (Legal Business Name): KOREAN COMMUNITY SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 01/28/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 W LINCOLN AVE
ANAHEIM CA
92805-2927
US

IV. Provider business mailing address

451 W LINCOLN AVE
ANAHEIM CA
92805-2927
US

V. Phone/Fax

Practice location:
  • Phone: 714-527-6561
  • Fax: 714-527-6563
Mailing address:
  • Phone: 714-527-6561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: KAY AHN
Title or Position: COO
Credential:
Phone: 714-527-6561