Active NPI
Soyon Park, PH.D.
- Psychologist
- Belmont, CA
National Provider Identifier
1154562288
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 3852 W Naughton Ave
Belmont, CA 94002-1260 - Phone
- (650) 520-0846
- NPI assigned
- Mar 19, 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 | Primary |
Addresses
Primary practice location
3852 W Naughton Ave
Belmont, CA 94002-1260
Mailing address
3852 W Naughton Ave
Belmont, CA 94002-1260
Phone (650) 520-0846
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2026 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1237420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308614400000",
"number": "1154562288",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3852 W NAUGHTON AVE",
"city": "BELMONT",
"state": "CA",
"postal_code": "940021260",
"telephone_number": "650-520-0846",
"fax_number": "650-697-0350"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3852 W NAUGHTON AVE",
"city": "BELMONT",
"state": "CA",
"postal_code": "940021260",
"telephone_number": "650-520-0846"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "SOYON",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-03-19",
"last_updated": "2011-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Belmont, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2011; 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.