MEDICARE: LOMITA HEALTH MANAGEMENT, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center	06000862	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093824369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOMITA HEALTH MANAGEMENT, INC.

Provider Business Mailing Address
First Line	:	1234 LOMITA BOULEVARD
Second Line	:	SUITE E
City	:	HARBOR CITY
State	:	CA
Zip	:	90710-2147
Country	:	US
Telephone Number	:	310-539-4800
Fax Number	:	310-539-4813

Provider Business Practice Location Address
First Line	:	1234 LOMITA BOULEVARD
Second Line	:	SUITE E
City	:	HARBOR CITY
State	:	CA
Zip	:	90710-2147
Country	:	US
Telephone Number	:	310-539-4800
Fax Number	:	310-539-4813

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MR. TAEWOONG KIM
Credential	:
Telephone Number	:	310-539-4800

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	12/02/2025

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