Provider Demographics
NPI:1952646796
Name:KOREAN AMERICAN SENIOR CENTER, INC
Entity Type:Organization
Organization Name:KOREAN AMERICAN SENIOR CENTER, INC
Other - Org Name:HANUL FAMILY ALLIANCE (D/B/A)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-478-8851
Mailing Address - Street 1:5008 N. KEDZIE AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625
Mailing Address - Country:US
Mailing Address - Phone:773-478-8851
Mailing Address - Fax:773-478-8552
Practice Address - Street 1:5008 N KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-4914
Practice Address - Country:US
Practice Address - Phone:773-478-8851
Practice Address - Fax:773-478-8552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========912Medicaid