Active NPI
Kevin Warren Park, M.D.
- Child & Adolescent Psychiatry Physician
- Salinas, CA
National Provider Identifier
1013045343
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- G65353
- Practice address
- 124 River Rd
Kinship Center
Salinas, CA 93908-9601 - Phone
- (831) 455-4770
- Fax
- (831) 455-4739
- NPI assigned
- Feb 28, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | G65353 | CA | Primary |
Addresses
Primary practice location
124 River Rd
Kinship Center
Salinas, CA 93908-9601
Mailing address
124 River Rd
Kinship Center
Salinas, CA 93908-9601
Phone (831) 455-4770
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G65363 | Other | CA | STATE MEDICAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G65353 | CA | MD | Child & Adolescent Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1013045343",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "124 RIVER RD",
"address_2": "KINSHIP CENTER",
"city": "SALINAS",
"state": "CA",
"postal_code": "939089601",
"telephone_number": "831-455-4770",
"fax_number": "831-455-4739"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "124 RIVER RD",
"address_2": "KINSHIP CENTER",
"city": "SALINAS",
"state": "CA",
"postal_code": "939089601",
"telephone_number": "831-455-4770",
"fax_number": "831-455-4739"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "KEVIN",
"middle_name": "WARREN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-28",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "CA",
"license": "G65353",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE MEDICAL LICENSE",
"identifier": "G65363",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salinas, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.