Provider Demographics
NPI:1497933691
Name:KORYO HEALTH FOUNDATON
Entity Type:Organization
Organization Name:KORYO HEALTH FOUNDATON
Other - Org Name:KORYO HEALTH FOUNDATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOON
Authorized Official - Middle Name:JU
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-675-4909
Mailing Address - Street 1:2655 W OLYMPIC BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2800
Mailing Address - Country:US
Mailing Address - Phone:213-380-8833
Mailing Address - Fax:213-368-6047
Practice Address - Street 1:2655 W OLYMPIC BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2800
Practice Address - Country:US
Practice Address - Phone:213-380-8833
Practice Address - Fax:213-368-6047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960000265261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAP70381FMedicaid
CA1760408470Medicaid
CA1306871413Medicaid
CAW11925Medicare UPIN
CA1760408470Medicaid