Provider Demographics
NPI:1699232454
Name:KWANG HE WON HEALTH CENTER
Entity type:Organization
Organization Name:KWANG HE WON HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BONGJA
Authorized Official - Middle Name:BENA
Authorized Official - Last Name:WON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-385-0448
Mailing Address - Street 1:815 S. ARDMORE AVE 1ST FLOOR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-2597
Mailing Address - Country:US
Mailing Address - Phone:213-385-0448
Mailing Address - Fax:213-260-8268
Practice Address - Street 1:815 S. ARDMORE AVE 1ST FLOOR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-2597
Practice Address - Country:US
Practice Address - Phone:213-385-0448
Practice Address - Fax:213-260-8268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-27
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA32086OtherCA MEDICAL BOARD