Basic Information
| Provider Information | |||||||||
| NPI: | 1366652430 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KOREATOWN YOUTH & COMMUNITY CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3727 W 6TH ST STE 402 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900205112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2133657400 | ||||||||
| FaxNumber: | 2132013993 | ||||||||
| Practice Location | |||||||||
| Address1: | 3727 W 6TH ST STE 402 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900205112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2133657400 | ||||||||
| FaxNumber: | 2132013993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 05/09/2019 | ||||||||
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| AuthorizedOfficialLastName: | SONG | ||||||||
| AuthorizedOfficialFirstName: | JOHNG HO | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2133657400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.