Provider Demographics
NPI:1912555202
Name:SUN BAY KOREATOWN, LLC
Entity Type:Organization
Organization Name:SUN BAY KOREATOWN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BENNETT
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-770-7091
Mailing Address - Street 1:905 S ARDMORE AVE APT 501
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-1457
Mailing Address - Country:US
Mailing Address - Phone:310-770-7091
Mailing Address - Fax:
Practice Address - Street 1:3060 W OLYMPIC BLVD # 120
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-3832
Practice Address - Country:US
Practice Address - Phone:213-471-8288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care