Healthcare Provider Details

I. General information

NPI: 1740124478
Provider Name (Legal Business Name): BOM VICHAE HOME HEALTH AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S BROOKHURST RD STE 108
FULLERTON CA
92833-4492
US

IV. Provider business mailing address

1401 S BROOKHURST RD STE 108
FULLERTON CA
92833-4492
US

V. Phone/Fax

Practice location:
  • Phone: 714-392-0876
  • Fax:
Mailing address:
  • Phone: 714-392-0876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KILHWAN YOU
Title or Position: OWNER
Credential: RN
Phone: 714-392-0876