MEDICARE: KHEIR MIRAE ADULT DAY HEALTH CARE CENTER

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	060000909	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ADU70398F	OTHER	CA	PROVIDER NUMBER

General Provider Information

NPI Number	:	1396964110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KHEIR MIRAE ADULT DAY HEALTH CARE CENTER

Provider Business Mailing Address
First Line	:	3727 W 6TH ST STE 210
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-5108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	717 S WESTERN AVE.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-3113
Country	:	US
Telephone Number	:	213-427-4000
Fax Number	:

Authorized Official
Title or Position	:	CEO - ADHC ADMINISTRATOR
Name	:	ERIN PAK
Credential	:
Telephone Number	:	213-427-4000

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	11/04/2020

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