Healthcare Provider Details

I. General information

NPI: 1215359039
Provider Name (Legal Business Name): KOREAN COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7281 GARDEN GROVE BLVD STE H
GARDEN GROVE CA
92841-4212
US

IV. Provider business mailing address

8633 KNOTT AVE
BUENA PARK CA
90620-3852
US

V. Phone/Fax

Practice location:
  • Phone: 714-539-4544
  • Fax:
Mailing address:
  • Phone: 714-527-6561
  • Fax: 714-527-6563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. KAY AHN
Title or Position: OPERATION DIRECTOR
Credential:
Phone: 714-527-6561