Healthcare Provider Details

I. General information

NPI: 1356173454
Provider Name (Legal Business Name): BEACH ADHC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4560 BEACH BLVD
BUENA PARK CA
90621-1100
US

IV. Provider business mailing address

4560 BEACH BLVD
BUENA PARK CA
90621-1100
US

V. Phone/Fax

Practice location:
  • Phone: 714-335-6074
  • Fax: 714-523-3706
Mailing address:
  • Phone: 714-335-6074
  • Fax: 714-523-3706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SU YONG PAK
Title or Position: OWNER
Credential:
Phone: 714-335-6074