Individual
DR. RANDALL LEE AHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD, MLIS
Contact information
Practice address
16465 SIERRA LAKES PKWY STE 140, FONTANA, CA 92336-1242
(909) 244-9593
(833) 903-0337
Mailing address
241 E 17TH ST # 1029, COSTA MESA, CA 92627-3831
(949) 414-7149
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PSY13956
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PSY13956
PSYCHOLOGY LICENSE
CA
Enumeration date
04/11/2007
Last updated
05/07/2024
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