NPIMap

Organization Active NPI

Korean Health, Education, Information and Research Center

  • Primary Care Clinic/Center
  • Los Angeles, CA
National Provider Identifier
1013311448
Registry record updated Mar 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
KOREAN HEALTH, EDUCATION, INFORMATION AND RESEARCH CENTER
Practice address
3255 Wilshire Blvd Ste 120
Los Angeles, CA 90010-1405
Phone
(213) 235-2500
Fax
(213) 355-8714
NPI assigned
Oct 14, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Erin Pak
Title
Chief Executive Officer
Phone
(213) 427-4000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X
Primary Care Clinic/Center 261QP2300X CA Primary

Addresses

Primary practice location

3255 Wilshire Blvd Ste 120
Los Angeles, CA 90010-1405

Mailing address

3727 W 6TH St Ste 210
Los Angeles, CA 90020-5108
Phone (213) 247-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150807015156 CA Part A Provider - Federally Qualified Health Center (FQHC) 9638180524 Practice locations: Los Angeles, CA

Federally qualified health center certification: CCN 751187

Legal name
KOREAN HEALTH EDUCATION INFORMATION AND RESEARCH CENTER
Doing business as
KHEIR WILSHIRE CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 20, 2015
Last certification
Jul 20, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 17, 1986 in CA
Enrollment address
3255 Wilshire Blvd
Ste 120
Los Angeles, CA 90010-1405

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kiesha Nix Individual Corporate DirectorBoard Member Jan 14, 2015
Karen Park Individual Corporate DirectorBoard Second Vice Chair Nov 1, 2013
Carolina Castillo Individual Corporate DirectorBoard Vice Chair Jan 14, 2015
Ji H Lee Individual Corporate DirectorBoard Vice Chair Jan 20, 2016
Ricky Seung Individual Corporate DirectorBoard First Vice Chair Nov 18, 2015
Michael Chang Individual Corporate DirectorBoard Member Nov 1, 2013
Dorothy Seleski Individual Corporate DirectorBoard Chair Jul 18, 2018
Stella S Kim Individual Corporate OfficerController Nov 1, 2013
W-2 Managing EmployeeController Nov 1, 2013
Operational/Managerial ControlController Nov 1, 2013
Erin Pak Individual Corporate OfficerChief Executive Officer Nov 1, 2013
W-2 Managing EmployeeChief Executive Officer Nov 1, 2013
Operational/Managerial ControlChief Executive Officer Nov 1, 2013
Phillip Lee Individual Corporate DirectorBoard Member Nov 1, 2013
Peter Rho Individual Corporate DirectorBoard Vice Chair Nov 1, 2013
Neena Master Individual Corporate DirectorBoard Member Jan 14, 2015
Korean Health Education Information and Research Center Organization, Los Angeles, CA Non-profit Operational/Managerial Control Sep 17, 1986 100%

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615420800000",
    "number": "1013311448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3727 W 6TH ST STE 210",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900205108",
            "telephone_number": "213-247-4000",
            "fax_number": "213-427-4008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3255 WILSHIRE BLVD STE 120",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900101405",
            "telephone_number": "213-235-2500",
            "fax_number": "213-355-8714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOREAN HEALTH, EDUCATION, INFORMATION AND RESEARCH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-14",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A",
        "authorized_official_last_name": "PAK",
        "authorized_official_first_name": "ERIN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "213-427-4000"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.