Healthcare Provider Details

I. General information

NPI: 1952460156
Provider Name (Legal Business Name): KORYO HEALTH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 W OLYMPIC BLVD STE 101
LOS ANGELES CA
90006-2800
US

IV. Provider business mailing address

2655 W OLYMPIC BLVD STE 101
LOS ANGELES CA
90006-2800
US

V. Phone/Fax

Practice location:
  • Phone: 213-380-8833
  • Fax:
Mailing address:
  • Phone: 213-380-8833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number960000265
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number960000265
License Number StateCA

VIII. Authorized Official

Name: MOON JU KIM
Title or Position: CEO
Credential:
Phone: 213-675-4909