Active NPI
Toshiaki Udo, PH.D.
- Clinical Psychologist
- Pasadena, CA
National Provider Identifier
1063524700
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY15090
- Practice address
- 97 W Bellevue Dr
Suite 1
Pasadena, CA 91105-2501 - Phone
- (626) 282-5744
- Fax
- (626) 795-3527
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY15090 | CA | Primary |
Addresses
Primary practice location
97 W Bellevue Dr
Suite 1
Pasadena, CA 91105-2501
Mailing address
2270 Adair St
San Marino, CA 91108-2606
Phone (626) 289-5681
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY150900 | Medicaid | CA |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY15090 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063524700",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2270 ADAIR ST",
"city": "SAN MARINO",
"state": "CA",
"postal_code": "911082606",
"telephone_number": "626-289-5681"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "97 W BELLEVUE DR",
"address_2": "SUITE 1",
"city": "PASADENA",
"state": "CA",
"postal_code": "911052501",
"telephone_number": "626-282-5744",
"fax_number": "626-795-3527"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UDO",
"first_name": "TOSHIAKI",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY15090",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PSY150900",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.