Randall Lee Ahn, PHD, MLIS

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

PSY13956 Issued in CA

Practice address

16465 Sierra Lakes Pkwy Ste 140
Fontana, CA 92336-1242

Phone

(909) 244-9593

Fax

(833) 903-0337

NPI assigned

Apr 11, 2007

Last updated

May 7, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Anthony Benigno, PSYD., Psychological Services, PC

  dba AB Psych Consulting

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fontana, CA
  • NPI 1295202943
  Medicare reassignment NPD

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715040000000",
    "number": "1093939399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "241 E 17TH ST # 1029",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926273831",
            "telephone_number": "949-414-7149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16465 SIERRA LAKES PKWY STE 140",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923361242",
            "telephone_number": "909-244-9593",
            "fax_number": "833-903-0337"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3137 Dwight Rd Ste 600",
            "address_purpose": "LOCATION",
            "city": "Elk Grove",
            "state": "CA",
            "postal_code": "957586472",
            "country_code": "US",
            "telephone_number": "909-244-9593",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5201 Great America Pkwy Ste 320",
            "address_purpose": "LOCATION",
            "city": "Santa Clara",
            "state": "CA",
            "postal_code": "950541140",
            "country_code": "US",
            "telephone_number": "323-205-7088",
            "fax_number": "833-419-0181",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AHN",
        "first_name": "RANDALL",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "PHD, MLIS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-11",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "CA",
            "license": "PSY13956",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHOLOGY LICENSE",
            "identifier": "PSY13956",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adriana Aguilera Alvarez, CHW
• Chioma Ahaiwe
• Najjia Shahabuddin Ahmed, M.D.
• Jenny Hyo Jung Ahn, PHARM D
• Kent Eunbae Ahn, MD
• Samuel T Ahn, MD
• Beverly Ahoni, M.D.
• Saveen Ahuja
• Joachim Ikponmwosa Airen
• Martha C Ajca, P.A.C

• Clinical Child & Adolescent Psychologist in Fontana, CA
• Providers in Fontana, CA by specialty
• Clinical Child & Adolescent Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.