| Pacifica Foundation Llc. | |
|
1300 N Vermont Ave Ste 407 Los Angeles CA 90027-6086 | |
| (323) 913-4524 | |
| (323) 913-4826 |
| Full Name | Pacifica Foundation Llc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1300 N Vermont Ave Ste 407, Los Angeles, California |
| Authorized Official Name and Position | Jamie Yoo (PRESIDENT) |
| Authorized Official Contact | 3239134914 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pacifica Foundation Llc. 1300 N Vermont Ave Ste 407 Los Angeles CA 90027-6086 Ph: (323) 913-4524 | Pacifica Foundation Llc. 1300 N Vermont Ave Ste 407 Los Angeles CA 90027-6086 Ph: (323) 913-4524 |
| NPI Number | 1386352466 |
|---|---|
| Provider Enumeration Date | 11/08/2022 |
| Last Update Date | 08/29/2023 |
| Medicare PECOS PAC ID | 0648624718 |
|---|---|
| Medicare Enrollment ID | O20230922001415 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386352466 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | William T Long |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1023067055 PECOS PAC ID: 2163313966 Enrollment ID: I20040322001483 |
| Provider Name | Tae M Shin |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1750483723 PECOS PAC ID: 6901903061 Enrollment ID: I20070524000222 |
| Provider Name | H Michael Mynatt |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1326100207 PECOS PAC ID: 0446267181 Enrollment ID: I20081201000116 |
| Provider Name | Jamie C Lin |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1588960538 PECOS PAC ID: 8022286780 Enrollment ID: I20110725000035 |
| Provider Name | Ben Ha |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1043305774 PECOS PAC ID: 6800066523 Enrollment ID: I20120125000840 |
| Provider Name | Alfred S Hong |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1689901746 PECOS PAC ID: 6608033873 Enrollment ID: I20120131000802 |
| Provider Name | Somsupha Kanjanauthai |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1285843979 PECOS PAC ID: 9537315965 Enrollment ID: I20180830003239 |
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