Active NPI
Mi N Park
- Psychologist
- San Mateo, CA
National Provider Identifier
1013140268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY27071
- Practice address
- 1777 Borel PL Ste 210
San Mateo, CA 94402-3511 - Phone
- (415) 320-1864
- NPI assigned
- Sep 3, 2009
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY27071 | CA | Primary |
Addresses
Primary practice location
1777 Borel PL Ste 210
San Mateo, CA 94402-3511
Mailing address
1777 Borel PL Ste 210
San Mateo, CA 94402-3511
Phone (415) 320-1864
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 18, 2026 through May 18, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY27071 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761868800000",
"number": "1013140268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1777 BOREL PL STE 210",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944023511",
"telephone_number": "415-320-1864"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1777 BOREL PL STE 210",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944023511",
"telephone_number": "415-320-1864"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "MI",
"middle_name": "N",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-09-03",
"last_updated": "2025-10-31",
"certification_date": "2025-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY27071",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Mateo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.