Basic Information
| Provider Information | |||||||||
| NPI: | 1588252027 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KOREAN COMMUNITY SERVICES INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 451 W LINCOLN AVE STE 100 | ||||||||
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| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928052912 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6494 CABALLERO BLVD | ||||||||
| Address2: | |||||||||
| City: | BUENA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906201128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145036550 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2021 | ||||||||
| LastUpdateDate: | 01/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | AHN | ||||||||
| AuthorizedOfficialFirstName: | KAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 7145276561 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | KOREAN COMMUNITY SERVICES INC. | ||||||||
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| NPICertificationDate: | 01/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.