=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760042915
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KOREATOWN SENIOR CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2019
-----------------------------------------------------
Last Update Date | 08/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3400 W OLYMPIC BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90019-2122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-604-1778
-----------------------------------------------------
Fax | 323-334-4601
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3400 W OLYMPIC BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90019-2292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-334-4600
-----------------------------------------------------
Fax | 323-334-4601
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | HELEN BOYOUNG KIM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 213-604-1778
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------