Andy Park, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-21-56691 Issued in CA

Practice address

13847 E 14TH St Ste 217
San Leandro, CA 94578-2626

Phone

(888) 805-0759

NPI assigned

Apr 6, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1522972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1558868588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 S MAYFLOWER AVE STE 220",
            "city": "MONROVIA",
            "state": "CA",
            "postal_code": "910164066",
            "telephone_number": "888-805-0759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13847 E 14TH ST STE 217",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945782626",
            "telephone_number": "888-805-0759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "ANDY",
        "name_prefix": "Mr.",
        "credential": "BCBA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-06",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "1-21-56691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leticia Paredes
• Yvette Jennifer Paredes
• Jesse Nathaniel Parham III
• Victoria Lee Paris
• Matthias Parish
• Chris Junbum Park, DDS
• Connie Jung Park, MD
• David Kyung-Il Park, M.D.
• Erika Seoyeon Park, OD
• Jeong Ho Park

• Behavior Analyst in San Leandro, CA
• Providers in San Leandro, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.