Organization
KORYO HEALTH FOUNDATION
Active
Other names
Koryo Health Foundation Community Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MOON JU KIM (CEO)
(213) 675-4909
Entity
Organization
Contact information
Practice address
2655 W OLYMPIC BLVD STE 101, LOS ANGELES, CA 90006-2800
(213) 380-8833
Mailing address
2655 W OLYMPIC BLVD STE 101, LOS ANGELES, CA 90006-2800
(213) 380-8833
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
960000265
CA
261QP2300X
Primary Care Clinic/Center
Primary
960000265
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306871413
—
CA
05
—
1760408470
—
CA
05
—
CMM70381F
—
CA
05
—
EAP70381F
—
CA
05
—
HAP70381F
—
CA
01
—
W11952
MEDICARE
CA
Enumeration date
12/06/2006
Last updated
02/14/2023
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