Provider Demographics
NPI:1780622738
Name:YONSEI MEDICAL CENTER A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:YONSEI MEDICAL CENTER A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRICO
Authorized Official - Middle Name:V
Authorized Official - Last Name:MUNGCAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-370-6211
Mailing Address - Street 1:21150 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4602
Mailing Address - Country:US
Mailing Address - Phone:310-370-6211
Mailing Address - Fax:310-370-9050
Practice Address - Street 1:21150 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4602
Practice Address - Country:US
Practice Address - Phone:310-370-6211
Practice Address - Fax:310-370-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty