Active NPI
James Byung Park, PHD
- Psychologist
- Camp Roberts, CA
National Provider Identifier
1295581189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 0810008050
- Practice address
- 18000 E Perimeter Road
Camp Roberts, CA 93451 - Phone
- (805) 227-7833
- NPI assigned
- Apr 30, 2024
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 0810008050 | VA | Primary |
Addresses
Primary practice location
18000 E Perimeter Road
Camp Roberts, CA 93451
Mailing address
2770 Stonebrook Cir
Paso Robles, CA 93446-9501
Phone (310) 295-8174
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 Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810008050 | VA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1714435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714435200000",
"number": "1295581189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2770 STONEBROOK CIR",
"city": "PASO ROBLES",
"state": "CA",
"postal_code": "934469501",
"telephone_number": "310-295-8174"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18000 E PERIMETER ROAD",
"city": "CAMP ROBERTS",
"state": "CA",
"postal_code": "93451",
"telephone_number": "805-227-7833"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "JAMES",
"middle_name": "BYUNG",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-04-30",
"last_updated": "2024-04-30",
"certification_date": "2024-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "VA",
"license": "0810008050",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.