=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093509242
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KANNA UEHARA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2025
-----------------------------------------------------
Last Update Date | 05/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 680 E. COLORADO BLVD SUITE 180 AND 2ND FLOOR
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-941-7645
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9227 RESEDA BLVD # 410
-----------------------------------------------------
City | NORTHRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91324-3137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-674-4408
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 29614
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------