MEDICARE: KORYO MEDICAL CENTER, A PROFESSIONAL CO.

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	208D00000X	General Practice Physician	A33441	CA

General Provider Information

NPI Number	:	1730191909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KORYO MEDICAL CENTER, A PROFESSIONAL CO.

Provider Business Mailing Address
First Line	:	2120 W 8TH ST STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-4082
Country	:	US
Telephone Number	:	213-387-5400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2120 W 8TH ST STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-4082
Country	:	US
Telephone Number	:	213-387-5400
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JEKO BEHFARIN
Credential	:	MD
Telephone Number	:	213-387-5400

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	08/22/2020

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