John Park, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY30065 Issued in CA

Practice address

1370 Valley Vista Dr Ste 200
Diamond Bar, CA 91765

Phone

(909) 274-9119

NPI assigned

Sep 19, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1348012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532649600000",
    "number": "1750632501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1317 S DIAMOND BAR BLVD UNIT 4233",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917655610",
            "telephone_number": "909-274-9119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1370 VALLEY VISTA DR STE 200",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "91765",
            "telephone_number": "909-274-9119"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10470 Foothill Blvd",
            "address_purpose": "LOCATION",
            "city": "Rancho Cucamonga",
            "state": "CA",
            "postal_code": "917303754",
            "country_code": "US",
            "telephone_number": "909-274-9119",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "24920 Mound St",
            "address_purpose": "LOCATION",
            "city": "Loma Linda",
            "state": "CA",
            "postal_code": "923500001",
            "country_code": "US",
            "telephone_number": "909-651-2257",
            "fax_number": "909-651-2257",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-09-19",
        "last_updated": "2018-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "30065",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY30065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Parvita Paresh Panchal, DO
• Lucas Ivan Paredes, D.C
• Angela Park
• Grace Park, D.C.
• Hee Bang Park, ACUPUNCTURIST
• Jong Ho Park, LAC.
• Ritchie Park, D.D.S.
• Shin Park
• Ashley Marie Tolentino Pascua, PTA
• Dilipkumar G Patel, DDS

• Clinical Psychologist in Diamond Bar, CA
• Providers in Diamond Bar, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2018; 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.