Kenneth John De Haan, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS13281 Issued in CA

Practice address

704 West 8TH Street
San Pedro, CA 90731

Phone

(310) 832-7545

Fax

(310) 833-8580

NPI assigned

Mar 29, 2007

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• The San Pedro Clinic

  • Point of Service
  • San Pedro, CA
  • NPI 1467766691
  NPD (past)

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370908800000",
    "number": "1174643753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "704 W 8TH ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907313017",
            "telephone_number": "310-832-7545",
            "fax_number": "310-833-8580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 WEST 8TH STREET",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "90731",
            "telephone_number": "310-832-7545",
            "fax_number": "310-833-8580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE HAAN",
        "first_name": "KENNETH",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-29",
        "last_updated": "2013-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS13281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Davis
• Stephanie Colleen Davis, HYG
• Cristina L. Dawes, LMFT
• Jeffrey Paul Dayton, M.D.
• Maria Renalyn Red De Gala, RNFA
• Ana Maria De la Torre, PH.D.
• Helena De Lang
• Margaret Rose De Lara
• Parvaneh Delbakhsh, M.D.
• Christopher Jospeh Deledonne, D.D.S.

• Clinical Social Worker in San Pedro, CA
• Providers in San Pedro, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.