Healthcare Provider Details

I. General information

NPI: 1821480377
Provider Name (Legal Business Name): KORUS MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2015
Last Update Date: 06/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 CENTERPOINTE DR. 115
LA PALMA CA
90623-2567
US

IV. Provider business mailing address

26 CENTERPOINTE DR. 115
LA PALMA CA
90623-2567
US

V. Phone/Fax

Practice location:
  • Phone: 714-670-0007
  • Fax: 714-670-0005
Mailing address:
  • Phone: 714-670-0007
  • Fax: 714-670-0005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. JOON HO LEE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-670-0007