Provider Demographics
NPI:1881210318
Name:LIVINGSTONE COMMUNITY DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:LIVINGSTONE COMMUNITY DEVELOPMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KYUNG
Authorized Official - Middle Name:I
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-248-9500
Mailing Address - Street 1:111 W BASTANCHURY RD
Mailing Address - Street 2:UNIT 1A
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2527
Mailing Address - Country:US
Mailing Address - Phone:714-248-9500
Mailing Address - Fax:714-622-4943
Practice Address - Street 1:111 W BASTANCHURY RD
Practice Address - Street 2:UNIT 1A
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2527
Practice Address - Country:US
Practice Address - Phone:714-248-9500
Practice Address - Fax:714-622-4943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-20
Last Update Date:2020-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty