Active NPI
Jiyea Park
- Occupational Therapist
- Mesa, AZ
National Provider Identifier
1417543471
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- Practice address
- 10165 E Hampton Ave Ste 111
Mesa, AZ 85209-3327 - Phone
- (480) 354-5424
- NPI assigned
- Dec 14, 2020
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | Primary |
Addresses
Primary practice location
10165 E Hampton Ave Ste 111
Mesa, AZ 85209-3327
Mailing address
631 W Pantera Ave
Mesa, AZ 85210-8320
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607904000000",
"number": "1417543471",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "631 W PANTERA AVE",
"city": "MESA",
"state": "AZ",
"postal_code": "852108320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10165 E HAMPTON AVE STE 111",
"city": "MESA",
"state": "AZ",
"postal_code": "852093327",
"telephone_number": "480-354-5424"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "JIYEA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-12-14",
"last_updated": "2020-12-14",
"certification_date": "2020-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.