Provider Demographics
NPI:1184102287
Name:KOREATOWN COMMUNITY BASED ADULT SERVICES, INC.
Entity type:Organization
Organization Name:KOREATOWN COMMUNITY BASED ADULT SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAEWOONG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-378-0101
Mailing Address - Street 1:2140 W OLYMPIC BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2250
Mailing Address - Country:US
Mailing Address - Phone:213-378-0101
Mailing Address - Fax:213-378-0106
Practice Address - Street 1:2140 W OLYMPIC BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2250
Practice Address - Country:US
Practice Address - Phone:213-378-0101
Practice Address - Fax:213-378-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-31
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care