NPIMap

Organization Active NPI

Korean Health Education Information and Research Center

  • Primary Care Clinic/Center
  • Los Angeles, CA
National Provider Identifier
1902568330
Registry record updated Oct 13, 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 100
Los Angeles, CA 90010-1405
Phone
(213) 235-2500
Fax
(213) 355-8714
NPI assigned
Oct 13, 2021
Last updated
Oct 13, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
KOREAN HEALTH EDUCATION INFORMATION AND RESEARCH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 13, 2021

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

Authorized official

Name
Shadman Chowdhury
Title
Practice Development Specialist
Phone
(213) 235-1212

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

3255 Wilshire Blvd Ste 100
Los Angeles, CA 90010-1405

Mailing address

3727 W 6TH St Ste 210
Los Angeles, CA 90020-5108
Phone (213) 235-2500

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211216001954 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 1902568330. Details of each certification follow.

Federally qualified health center certification: CCN A01038

Legal name
KOREAN HEALTH EDUCATION INFORMATION AND RESEARCH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 2, 2021
Last certification
Dec 2, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 17, 1986 in CA
Enrollment address
3255 Wilshire Blvd
Ste 100
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
Tax ID family
Kheir Adult Day Health Care Center - Vermont7 organizations share this tax ID, including this one
Part of
Kheir Adult Day Health Care Center - Vermont

Other organizations with this tax ID 6

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

Locations

3727 W 6th St
Ste 210
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
Kiesha Nix Individual Corporate DirectorMember, Board of Directors Jan 14, 2015
Karen Park Individual Corporate DirectorMember, Board of Directors Jul 21, 2005
Carolina Castillo Individual Corporate DirectorMember, Board of Directors Jan 22, 2019
Ji H Lee Individual Corporate DirectorBoard Member Jan 1, 2016
Ricky Seung Individual Corporate DirectorBoard Member Sep 13, 2015
Michael Chang Individual Corporate DirectorMember, Board of Directors Jan 1, 2007
Dorothy Seleski Individual Corporate DirectorBoard Member Jun 22, 2018
Eugene Eng Individual Corporate Director1St Vice Chair, Board of Directors Jan 27, 2011
Stella S Kim Individual Corporate OfficerChief Financial Officer Jun 1, 2021
Bart Christensen Individual Corporate DirectorMember, Board of Directors May 12, 2005
Erin Pak Individual Corporate OfficerChief Executive Officer Dec 1, 2004 100%
Operational/Managerial ControlChief Executive Officer Dec 1, 2004 100%
Phillip Lee Individual Corporate DirectorMember, Board of Directors Jan 14, 2014
Peter Rho Individual Corporate DirectorMember, Board of Directors May 22, 2008
Neena Master Individual Corporate DirectorChair, Board of Directors Jan 14, 2015

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 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": "1634083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634083200000",
    "number": "1902568330",
    "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": "213-235-2500",
            "fax_number": "213-427-4008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3255 WILSHIRE BLVD STE 100",
            "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": "YES",
        "parent_organization_legal_business_name": "KOREAN HEALTH EDUCATION INFORMATION AND RESEARCH CENTER",
        "enumeration_date": "2021-10-13",
        "last_updated": "2021-10-13",
        "certification_date": "2021-09-28",
        "status": "A",
        "authorized_official_last_name": "CHOWDHURY",
        "authorized_official_first_name": "SHADMAN",
        "authorized_official_title_or_position": "PRACTICE DEVELOPMENT SPECIALIST",
        "authorized_official_telephone_number": "213-235-1212"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.