Provider Demographics
NPI:1578120143
Name:KOREATOWN YOUTH AND COMMUNITY CENTER, INC.
Entity Type:Organization
Organization Name:KOREATOWN YOUTH AND COMMUNITY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-365-7400
Mailing Address - Street 1:3727 W 6TH ST STE 411
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-5112
Mailing Address - Country:US
Mailing Address - Phone:213-365-7400
Mailing Address - Fax:
Practice Address - Street 1:3727 W 6TH ST STE 402
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-5112
Practice Address - Country:US
Practice Address - Phone:213-365-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-20
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health