Theodore Ahn
Individual provider Active NPI Clinical Social Worker · South Pasadena, CA
NPI 1851687701 · NPPES record last updated Jun 17, 2024
Key facts
- NPI
- 1851687701
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 122045 (CA)
- Practice address
- 205 Pasadena Ave
South Pasadena, CA 91030-2919 - Phone
- (323) 344-5538
- NPI assigned
- Jun 20, 2011
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 122045 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Institute for the Redesign of Learning | Mental Health | Past | Accepting new patients |
| Institute for the Redesign of Learning | Mental Health | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Clinical Social Worker | 1041C0700X | 122045 | CA | Yes |
Addresses
Primary practice location
205 Pasadena Ave
South Pasadena, CA 91030-2919
Mailing address
2130 E 4TH St
Santa Ana, CA 92705-3818
Other practice location 1
2130 E 4th St
Santa Ana, CA 92705-3818
Phone (714) 543-5437 ext. 1156
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7708 | Other | CA | MEDICAL |
| 7368 | Other | CA | MEDICAL |
| 7667 | Other | CA | MEDICAL |
| 7184 | Other | CA | MEDICAL |
Other providers in South Pasadena, CA
- David Aguilar
- Olga Aguilar
- Jacqueline Cuajao Aguillon
- Maria Nina Joy Aguirre
- Kathie Youngmee Ahn
- Armando Ahumada
- Akanifiok Clement Inyang Friendly Medical Supply
- Illham H Al-Sarraf Rope
- Hala Ahmed Al-Tarifi
- Jamille Ala
All providers in South Pasadena, CA · Clinical Social Worker in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.