Provider Demographics
NPI:1952460156
Name:KORYO HEALTH FOUNDATION
Entity Type:Organization
Organization Name:KORYO HEALTH FOUNDATION
Other - Org Name:KORYO HEALTH FOUNDATION COMMUNITY CLINIC
Other - Org Type:Other Name
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960000265208D00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAP70381FMedicaid
CAEAP70381FMedicaid
CACMM70381FMedicaid
CA1306871413Medicaid
CA1760408470Medicaid
CAW11952OtherMEDICARE
CAEAP70381FMedicaid
CAHAP70381FMedicaid