Healthcare Provider Details

I. General information

NPI: 1073849980
Provider Name (Legal Business Name): SKK HERITAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 11/06/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14640 VICTORY BLVD. #100
VAN NUYS CA
91411-1623
US

IV. Provider business mailing address

14640 VICTORY BLVD. #100
VAN NUYS CA
91411-1623
US

V. Phone/Fax

Practice location:
  • Phone: 818-781-8777
  • Fax: 818-781-8775
Mailing address:
  • Phone: 818-781-8777
  • Fax: 818-781-8775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number060000835
License Number StateCA

VIII. Authorized Official

Name: MR. JINWOO KIM
Title or Position: CEO
Credential:
Phone: 818-781-8777