Healthcare Provider Details

I. General information

NPI: 1184102287
Provider Name (Legal Business Name): KOREATOWN COMMUNITY BASED ADULT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 W OLYMPIC BLVD STE 100
LOS ANGELES CA
90006-2250
US

IV. Provider business mailing address

2140 W OLYMPIC BLVD STE 100
LOS ANGELES CA
90006-2250
US

V. Phone/Fax

Practice location:
  • Phone: 213-378-0101
  • Fax: 213-378-0106
Mailing address:
  • Phone: 213-378-0101
  • Fax: 213-378-0106

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: ADMINISTRATOR
Credential:
Phone: 213-378-0101