Active NPI
Michael Ichinaga, PH.D.
- Clinical Psychologist
- San Jose, CA
National Provider Identifier
1700035672
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY12062
- Practice address
- 828 S Bascom Ave
San Jose, CA 95128-2651 - Phone
- (408) 885-5776
- NPI assigned
- Sep 15, 2008
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY12062 | CA | Primary |
Addresses
Primary practice location
828 S Bascom Ave
San Jose, CA 95128-2651
Mailing address
1901 Halford Ave Apt 185
Santa Clara, CA 95051-7413
Phone (408) 261-2284
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 |
|---|---|---|---|
| PSY12062 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221436800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221436800000",
"number": "1700035672",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1901 HALFORD AVE APT 185",
"city": "SANTA CLARA",
"state": "CA",
"postal_code": "950517413",
"telephone_number": "408-261-2284"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "828 S BASCOM AVE",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951282651",
"telephone_number": "408-885-5776"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ICHINAGA",
"first_name": "MICHAEL",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-09-15",
"last_updated": "2008-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY12062",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.