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General NPI Number Information
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NPI Number | 1053723866
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Entity Type | Individual
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Provider Name | SAMANTHA CHHIM MAEDA
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Gender | Female
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Dates
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Enumeration Date | 05/28/2014
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Last Update Date | 12/26/2017
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Provider Practice Location Address
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Address Line | 1331 1/2 W 168TH ST # B
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City | GARDENA
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State | CA
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Zip | 90247-5509
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Country | US
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Telephone | 714-330-2408
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Fax |
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Provider Business Mailing Address
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Address Line | 1331 1/2 W 168TH ST # B
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City | GARDENA
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State | CA
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Zip | 90247-5509
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 63150
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 80887
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License Number State | CA
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