NPIMap

Organization Active NPI

Michelle Jo Park, MD, Inc.

  • Psychiatry Physician
  • Irvine, CA
National Provider Identifier
1740677111
Registry record updated Apr 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A106354 Issued in CA
Legal business name
MICHELLE JO PARK, MD, INC.
Practice address
4199 Campus Dr
Suite 550
Irvine, CA 92612-4684
Phone
(949) 864-6784
NPI assigned
Apr 23, 2015
Last updated
Apr 23, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2015

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

Authorized official

Name
Michelle Park, M.D.NPI 1730346024
Title
Ceo
Phone
(949) 864-6784

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X A106354 CA Primary

Addresses

Primary practice location

4199 Campus Dr
Suite 550
Irvine, CA 92612-4684

Mailing address

4199 Campus Dr
Suite 550
Irvine, CA 92612-4684

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1429747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429747200000",
    "number": "1740677111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4199 CAMPUS DR",
            "address_2": "SUITE 550",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926124684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4199 CAMPUS DR",
            "address_2": "SUITE 550",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926124684",
            "telephone_number": "949-864-6784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHELLE JO PARK, MD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-23",
        "last_updated": "2015-04-23",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-864-6784",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A106354",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Irvine, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2015; 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.