Basic Information
| Provider Information | |||||||||
| NPI: | 1730323585 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CYS KOREAN COMMUNITY SERVICES OCAPICA FSP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 451 W LINCOLN AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928052912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145276561 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7212 ORANGETHORPE AVE STE 8 | ||||||||
| Address2: | |||||||||
| City: | BUENA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906214667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144491125 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2009 | ||||||||
| LastUpdateDate: | 02/20/2020 | ||||||||
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| AuthorizedOfficialLastName: | AHN | ||||||||
| AuthorizedOfficialFirstName: | ELLEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7145276561 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ORANGE COUNTY ASIAN AND PACIFIC ISLANDER COMMUNITY ALLIANCE, INC. | ||||||||
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| NPICertificationDate: | 02/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.