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General NPI Number Information
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NPI Number | 1912555202
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Entity Type | Organization
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Legal Business Name | SUN BAY KOREATOWN, LLC
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Dates
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Enumeration Date | 08/29/2019
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Last Update Date | 08/29/2019
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Provider Practice Location Address
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Address Line | 3060 W OLYMPIC BLVD # 120
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City | LOS ANGELES
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State | CA
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Zip | 90006-3832
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Country | US
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Telephone | 213-471-8288
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Fax |
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Provider Business Mailing Address
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Address Line | 905 S ARDMORE AVE APT 501
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City | LOS ANGELES
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State | CA
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Zip | 90006-1457
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Country | US
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Telephone | 310-770-7091
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BENNETT KIM
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Credential |
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Telephone | 310-770-7091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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