=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417828823
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KWANG HE WON HEALTH CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2025
-----------------------------------------------------
Last Update Date | 09/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2423 N BROADWAY
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90031-2218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-376-3762
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 815 S ARDMORE AVE FL 1
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90005-2597
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-385-0448
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | BONGJA BENA WON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 213-385-0448
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------