| Ssg Kycc | |
|
3727 W 6th St Suite 402 Los Angeles CA 90020-5112 | |
| (213) 365-7400 | |
| (213) 201-3993 |
| Full Name | Ssg Kycc |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 3727 W 6th St, Los Angeles, California |
| Authorized Official Name and Position | Herbert K Hatanaka (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2135531822 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ssg Kycc 905 E 8th St Los Angeles CA 90021-1848 Ph: (213) 553-1800 | Ssg Kycc 3727 W 6th St Suite 402 Los Angeles CA 90020-5112 Ph: (213) 365-7400 |
| NPI Number | 1053776104 |
|---|---|
| Provider Enumeration Date | 12/16/2015 |
| Last Update Date | 11/23/2021 |
| Certification Date | 11/23/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053776104 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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