Provider Demographics
NPI:1952468910
Name:HANMI MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:HANMI MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAIK
Authorized Official - Middle Name:HYUN
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-480-0404
Mailing Address - Street 1:325 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3804
Mailing Address - Country:US
Mailing Address - Phone:213-480-0404
Mailing Address - Fax:213-480-1519
Practice Address - Street 1:325 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-3804
Practice Address - Country:US
Practice Address - Phone:213-480-0404
Practice Address - Fax:213-480-1519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A372300Medicaid
CAA37230OtherSTATE MEDICAL LICENSE NUMBER
CA00A372300Medicaid