Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kistiyaporn Keratisomphon, ACSW

Individual provider Clinical Social Worker · NPI 1417668344

Kistiyaporn Keratisomphon, ACSW is a Clinical Social Worker in Santa Ana, California. Practices as a sole proprietor. Licensed in California.

Licensed in
CA
In the registry since
2022

Practice location Address checks out

405 W 5th St
Santa Ana, CA 92701-4599
Phone: (714) 834-3101
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence ASW111234 (CA)

Record details

NPI number1417668344
Entity typeIndividual (Type 1)
GenderFemale
Credentials ACSW
Sole proprietorYes
NPI enumeratedDecember 12, 2022
Last updated in NPPESOctober 30, 2023
Certification dateOctober 30, 2023

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