Individual provider Active NPI

Christine Joohee Park, M.D.

  • Psychiatry Physician
  • Guadalupe, CA
National Provider Identifier
1790120053
Registry record updated Feb 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A133839 Issued in CA
Practice address
4723 W Main St
Guadalupe, CA 93434-1787
Phone
(805) 361-4910
NPI assigned
Apr 30, 2013
Last updated
Feb 17, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X V2806 TX
Psychiatry Physician 2084P0800X A133839 CA Primary

Addresses

Primary practice location

4723 W Main St
Guadalupe, CA 93434-1787

Mailing address

4723 W Main St Ste H
Guadalupe, CA 93434-1787
Phone (805) 361-4910

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241106004025 TX Practitioner - Psychiatry 9830454982 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A133839CAMDPsychiatry Physician
V2806TXMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Nazimuddin Mohammed MD PA CurrentSince Dec 1, 2024 Accepting new patients

Locations

11500 State Highway 121
Ste 510
Frisco, TX 75035
Phone (469) 200-4093

11500 State Highway 121
Ste 93
Frisco, TX 75035
Phone (469) 200-4093

11500 State Highway 121
Ste 930
Frisco, TX 75035
Phone (469) 200-4083

281 W Southlake Blvd
Bldg 10
Southlake, TX 76092
Phone (469) 200-4093

Interoperability endpoints

  • Direct secure messaging: christine.park.1@17363.direct.athenahealth.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1367280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771286400000",
    "number": "1790120053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4723 W MAIN ST STE H",
            "city": "GUADALUPE",
            "state": "CA",
            "postal_code": "934341787",
            "telephone_number": "805-361-4910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4723 W MAIN ST",
            "city": "GUADALUPE",
            "state": "CA",
            "postal_code": "934341787",
            "telephone_number": "805-361-4910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "CHRISTINE",
        "middle_name": "JOOHEE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-30",
        "last_updated": "2026-02-17",
        "certification_date": "2026-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "V2806",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A133839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Guadalupe, CA

Sources for this page

Verify at the official NPI Registry.