Healthcare Provider Details

I. General information

NPI: 1831964600
Provider Name (Legal Business Name): SOUTH BAY SENIOR HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 W REDONDO BEACH BLVD
GARDENA CA
90247-4128
US

IV. Provider business mailing address

22903 ADOLPH AVE
TORRANCE CA
90505-3545
US

V. Phone/Fax

Practice location:
  • Phone: 213-793-8763
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: TAEWOONG KIM
Title or Position: PRESIDENT
Credential:
Phone: 213-793-8763