NPIMap

Organization Active NPI

Livingstone Community Development Corporation

Doing business as Livingstone Community Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Fullerton, CA
National Provider Identifier
1881210318
Registry record updated Jun 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LIVINGSTONE COMMUNITY DEVELOPMENT CORPORATION
Doing business as
Livingstone Community Health Clinic
Practice address
111 W Bastanchury Rd
Unit 1a
Fullerton, CA 92835-2527
Phone
(714) 248-9500
Fax
(714) 622-4943
NPI assigned
Jun 20, 2020
Last updated
Jun 20, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2020

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

Authorized official

Name
Dr. Kyung I. Park, MDNPI 1942210570
Title
Ceo
Phone
(714) 248-9500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

111 W Bastanchury Rd
Unit 1a
Fullerton, CA 92835-2527

Mailing address

111 W Bastanchury Rd
Unit 1a
Fullerton, CA 92835-2527
Phone (714) 248-9500

Other names 1

  • Livingstone Community Health Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140724002386 CA Part B Supplier - Clinic/Group Practice 9931323706 Receives reassigned benefits from 12 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fullerton, CA; Stanton, CA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Livingstone Community Development Corporation3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1592611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592611200000",
    "number": "1881210318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 W BASTANCHURY RD",
            "address_2": "UNIT 1A",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928352527",
            "telephone_number": "714-248-9500",
            "fax_number": "714-622-4943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W BASTANCHURY RD",
            "address_2": "UNIT 1A",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928352527",
            "telephone_number": "714-248-9500",
            "fax_number": "714-622-4943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVINGSTONE COMMUNITY DEVELOPMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-20",
        "last_updated": "2020-06-20",
        "certification_date": "2020-06-20",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "KYUNG",
        "authorized_official_middle_name": "I.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "714-248-9500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Livingstone Community Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fullerton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.