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General NPI Number Information
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NPI Number | 1952460156
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Entity Type | Organization
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Legal Business Name | KORYO HEALTH FOUNDATION
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 02/14/2023
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Provider Practice Location Address
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Address Line | 2655 W OLYMPIC BLVD STE 101
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City | LOS ANGELES
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State | CA
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Zip | 90006-2800
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Country | US
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Telephone | 213-380-8833
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Fax |
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Provider Business Mailing Address
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Address Line | 2655 W OLYMPIC BLVD STE 101
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City | LOS ANGELES
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State | CA
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Zip | 90006-2800
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Country | US
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Telephone | 213-380-8833
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MOON JU KIM
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Credential |
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Telephone | 213-675-4909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 960000265
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 960000265
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License Number State | CA
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