| Kwang He Won Health Center | |
|
815 S. Ardmore Ave 1st Floor Los Angeles CA 90005-2597 | |
| (213) 385-0448 | |
| (213) 260-8268 |
| Full Name | Kwang He Won Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 815 S. Ardmore Ave 1st Floor, Los Angeles, California |
| Authorized Official Name and Position | Bongja Bena Won (CEO/PRESIDENT) |
| Authorized Official Contact | 2133850448 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kwang He Won Health Center 815 S. Ardmore Ave 1st Floor Los Angeles CA 90005-2597 Ph: (213) 385-0448 | Kwang He Won Health Center 815 S. Ardmore Ave 1st Floor Los Angeles CA 90005-2597 Ph: (213) 385-0448 |
| NPI Number | 1699232454 |
|---|---|
| Provider Enumeration Date | 02/27/2019 |
| Last Update Date | 03/02/2022 |
| Certification Date | 03/02/2022 |
| Medicare PECOS PAC ID | 0143630590 |
|---|---|
| Medicare Enrollment ID | O20201113001406 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699232454 | NPI | - | NPPES |
| A32086 | Other | CA | CA MEDICAL BOARD |
| Provider Name | Fernando T Enrile |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1073671814 PECOS PAC ID: 2466445861 Enrollment ID: I20040402001490 |
| Provider Name | Young S Suh |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1396708251 PECOS PAC ID: 8224079629 Enrollment ID: I20050516000969 |
| Provider Name | Jae W Lee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639265143 PECOS PAC ID: 6901995356 Enrollment ID: I20071207000585 |
| Provider Name | Helena S Park |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093061970 PECOS PAC ID: 5991948432 Enrollment ID: I20150929001967 |
| Provider Name | Daesoon Leem |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1902289226 PECOS PAC ID: 0749593697 Enrollment ID: I20200115000019 |
| Provider Name | Leslie A Langley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255779120 PECOS PAC ID: 9638487952 Enrollment ID: I20201005002033 |
| Provider Name | Richard J Bardowell |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1790796753 PECOS PAC ID: 2466769898 Enrollment ID: I20210217002229 |
| Provider Name | Ji Y Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912435553 PECOS PAC ID: 2466869516 Enrollment ID: I20210407002684 |
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