Provider Demographics
NPI:1417828823
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
Authorized Official - Prefix:
Authorized Official - First Name:BONGJA
Authorized Official - Middle Name:BENA
Authorized Official - Last Name:WON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-385-0448
Mailing Address - Street 1:815 S ARDMORE AVE FL 1
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:
Practice Address - Street 1:2423 N BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-2218
Practice Address - Country:US
Practice Address - Phone:213-376-3762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KWANG HE WON HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty