NPIMap

Organization Active NPI

Korean Health Education Information and Research Center

  • Primary Care Clinic/Center
  • Los Angeles, CA
National Provider Identifier
1437377454
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
960001098 Issued in CA
Legal business name
KOREAN HEALTH EDUCATION INFORMATION AND RESEARCH CENTER
Practice address
3727 W 6TH St Ste 200
Los Angeles, CA 90020-5108
Phone
(213) 235-2500
Fax
(213) 251-8647
NPI assigned
Apr 23, 2007
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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 960001098 CA Primary

Addresses

Primary practice location

3727 W 6TH St Ste 200
Los Angeles, CA 90020-5108

Mailing address

3727 W 6TH St Ste 200
Los Angeles, CA 90020-5108
Phone (213) 235-2500

Other identifiers 4

IdentifierTypeStateIssuer
BCP70813FOtherCACANCER DETECTION PROGRAM
EAP70813FOtherCAEAPC
FHC70813FMedicaidCA
HAP70813FOtherCAFAMILY PACT

Other names 1

  • KHEIR S. Mark Taper Foundation Community Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060505000908 CA Part B Supplier - Clinic/Group Practice 9638180524 Receives reassigned benefits from 30 practitioners
Practice locations: Los Angeles, CA
O20140812000819 CA Part A Provider - Federally Qualified Health Center (FQHC) 9638180524 Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437377454. Details of each certification follow.

Federally qualified health center certification: CCN 751090

Legal name
KOREAN HEALTH EDUCATION INFORMATION AND RESEARCH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 8, 2014
Last certification
Aug 8, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 17, 1986 in CA
Enrollment address
3727 W 6TH St 210
Los Angeles, CA 90020-5108

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

Locations

3727 W 6th St
Los Angeles, CA 90020
Phone (213) 234-8268

3727 W 6th St
Ste 200
Los Angeles, CA 90020
Phone (213) 235-2500

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Maryann Jackmon Individual Corporate Officer1St Vice Chair Board of Director Nov 1, 2013
Karen Park Individual Corporate OfficerMember Board of Directors Nov 1, 2013
Neyadhish Chakma Individual Operational/Managerial ControlVP Operations/Patient Services Nov 1, 2013
Stuart Bullard Individual Corporate OfficerMember Board of Directors Nov 1, 2013
Michael Chang Individual Corporate OfficerMember Board of Directors Nov 1, 2013
Eugene Eng Individual Corporate Officer2ND Vice Chair Board of Director Nov 1, 2013
Stella S Kim Individual W-2 Managing EmployeeController Nov 1, 2013
Bart Christensen Individual Corporate OfficerMember Board of Directors Nov 1, 2013
Tina Hahn Individual Corporate OfficerMember Board of Directors Nov 1, 2013
Erin Pak Individual Corporate OfficerCeo Nov 1, 2013
Operational/Managerial ControlCeo/Corporate Pres/Treasurer Nov 1, 2013
Phillip Lee Individual Corporate OfficerMember Board of Directors Nov 1, 2013
Peter Rho Individual Corporate OfficerChair Board of Directors Nov 1, 2013
Chang Park Individual Corporate OfficerMember Board of Directors Nov 1, 2013
Kirby Van Amburgh Individual Corporate OfficerCorporate Secretary Nov 1, 2013

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Kheir Wilshire ClinicLos Angeles, CA, CCN 751187 Federally qualified health center Operational/Managerial Control (100%) Sep 17, 1986

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1437377454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3727 W 6TH ST STE 200",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900205108",
            "telephone_number": "213-235-2500",
            "fax_number": "213-251-8647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3727 W 6TH ST STE 200",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900205108",
            "telephone_number": "213-235-2500",
            "fax_number": "213-251-8647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOREAN HEALTH EDUCATION INFORMATION AND RESEARCH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2022-07-21",
        "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": "960001098",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CANCER DETECTION PROGRAM",
            "identifier": "BCP70813F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EAPC",
            "identifier": "EAP70813F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70813F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAMILY PACT",
            "identifier": "HAP70813F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KHEIR S. Mark Taper Foundation Community Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.