| Koryo Health Foundation Community Clinic | |
|
2655 W Olympic Blvd Ste 101 Los Angeles CA 90006-2800 | |
| (213) 380-8833 | |
| Not Available |
| Full Name | Koryo Health Foundation Community Clinic |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 2655 W Olympic Blvd Ste 101, Los Angeles, California |
| Authorized Official Name and Position | Moon Ju Kim (CEO) |
| Authorized Official Contact | 2136754909 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Koryo Health Foundation Community Clinic 2655 W Olympic Blvd Ste 101 Los Angeles CA 90006-2800 Ph: (213) 380-8833 | Koryo Health Foundation Community Clinic 2655 W Olympic Blvd Ste 101 Los Angeles CA 90006-2800 Ph: (213) 380-8833 |
| NPI Number | 1952460156 |
|---|---|
| Provider Enumeration Date | 12/06/2006 |
| Last Update Date | 02/14/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952460156 | NPI | - | NPPES |
| HAP70381F | Medicaid | CA | |
| EAP70381F | Medicaid | CA | |
| CMM70381F | Medicaid | CA | |
| 1306871413 | Medicaid | CA | |
| 1760408470 | Medicaid | CA | |
| W11952 | Other | CA | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 960000265 (California) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | 960000265 (California) | Primary |
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