Koryo Health Foundation

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

960000265 Issued in CA

Legal business name

KORYO HEALTH FOUNDATION

Practice address

2655 W Olympic Blvd Ste 101
Los Angeles, CA 90006-2800

Phone

(213) 380-8833

NPI assigned

Dec 6, 2006

Organization subpart

No

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

Authorized official

Name

Moon Ju Kim

Title

Ceo

Phone

(213) 675-4909

Specialties & licenses 2

Addresses

Other identifiers 6

Other names 1

• Koryo Health Foundation Community Clinic Other name

Locations

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676332800000",
    "number": "1952460156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2655 W OLYMPIC BLVD STE 101",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900062800",
            "telephone_number": "213-380-8833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2655 W OLYMPIC BLVD STE 101",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900062800",
            "telephone_number": "213-380-8833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KORYO HEALTH FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2023-02-14",
        "certification_date": "2023-02-14",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "MOON",
        "authorized_official_middle_name": "JU",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "213-675-4909"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "960000265",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "960000265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HAP70381F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EAP70381F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70381F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306871413",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1760408470",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "W11952",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Koryo Health Foundation Community Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Koryo Health Foundation Community Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jens J Kort
• Shirley Rachel Korula, M.D.
• Korus Medical Group
• Korus Medical Group of Lee Chiropractic Corporation
• Koryo Health Foundation
• Koryo Health Foundaton (Koryo Health Foundation)
• Koryo Medical Center, a Professional Co.
• Amanda Kosack
• Rasagna Kosaraju, MD
• Revanth Kosaraju, MD

• Primary Care Clinic/Center in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.