Individual provider Active NPI

Kwang Ha, PH.D.

  • Clinical Psychologist
  • Los Angeles, CA
National Provider Identifier
1891059796
Registry record updated Aug 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
33013 Issued in CA
Practice address
1720 E 120TH St
Los Angeles, CA 90059-3052
Phone
(323) 298-3680
NPI assigned
Jun 26, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 3, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pastoral Counselor 101YP1600X BCPC 0593 VA
Clinical Psychologist 103TC0700X 024368 NY
Clinical Psychologist 103TC0700X 33013 CA Primary

Addresses

Primary practice location

1720 E 120TH St
Los Angeles, CA 90059-3052

Mailing address

19141 Golden Valley Rd # 1023
Santa Clarita, CA 91387-1428
Phone (213) 543-2884

Other practice location 1

19141 Golden Valley Rd # 1023
Santa Clarita, CA 91387-1428
Phone (213) 543-2884

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20220921002432 CA Practitioner - Clinical Psychologist 3779968169 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1720 E 120TH St
Los Angeles, CA 90059-3097
Phone (310) 668-4803

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
BCPC 0593VAMDPastoral Counselor
024368NYMDClinical Psychologist
33013CAMDSports Physician Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Los Angeles County Department of Mental Health Current Accepting new patients
Los Angeles County Department of Mental Health CurrentSince Jul 25, 2022 Accepting new patients
Los Angeles County Department of Mental Health CurrentSince Jul 25, 2022 Accepting new patients

Locations

1720 E 120th St
Los Angeles, CA 90059
Phone (310) 668-4272

510 S Vermont Ave
Fl 19
Los Angeles, CA 90020
Phone (213) 480-3416

3741 Stocker St
Ste 200
View Park, CA 90008
Phone (323) 290-5800

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1340668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659484800000",
    "number": "1891059796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19141 GOLDEN VALLEY RD # 1023",
            "city": "SANTA CLARITA",
            "state": "CA",
            "postal_code": "913871428",
            "telephone_number": "213-543-2884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 E 120TH ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900593052",
            "telephone_number": "323-298-3680"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19141 Golden Valley Rd # 1023",
            "address_purpose": "LOCATION",
            "city": "Santa Clarita",
            "state": "CA",
            "postal_code": "913871428",
            "country_code": "US",
            "telephone_number": "213-543-2884",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HA",
        "first_name": "KWANG",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-26",
        "last_updated": "2022-08-03",
        "certification_date": "2022-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP1600X",
            "taxonomy_group": "",
            "desc": "Counselor, Pastoral",
            "state": "VA",
            "license": "BCPC 0593",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "024368",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "33013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.