Active NPI
Samantha Chhim Maeda
- Clinical Social Worker
- Gardena, CA
National Provider Identifier
1053723866
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 80887
- Practice address
- 1331 1/2 W 168TH St # B
Gardena, CA 90247-5509 - Phone
- (714) 330-2408
- NPI assigned
- May 28, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 63150 | CA | |
| Clinical Social Worker | 1041C0700X | 80887 | CA | Primary |
Addresses
Primary practice location
1331 1/2 W 168TH St # B
Gardena, CA 90247-5509
Mailing address
1331 1/2 W 168TH St # B
Gardena, CA 90247-5509
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 80887 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1401235200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1514246400000",
"number": "1053723866",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1331 1/2 W 168TH ST # B",
"city": "GARDENA",
"state": "CA",
"postal_code": "902475509"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1331 1/2 W 168TH ST # B",
"city": "GARDENA",
"state": "CA",
"postal_code": "902475509",
"telephone_number": "714-330-2408"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAEDA",
"first_name": "SAMANTHA",
"middle_name": "CHHIM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-05-28",
"last_updated": "2017-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "63150",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "80887",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gardena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.