Active NPI
Michael Ichiyama, PH.D.
- Clinical Psychologist
- San Diego, CA
National Provider Identifier
1932856341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY15294
- Practice address
- 5998 Alcala Park
San Diego, CA 92110-8001 - Phone
- (858) 245-4936
- NPI assigned
- Mar 5, 2022
- 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 | PSY15294 | CA | Primary |
Addresses
Primary practice location
5998 Alcala Park
San Diego, CA 92110-8001
Mailing address
6615 Canyon Rim Row Unit 153
San Diego, CA 92111-7441
Phone (858) 245-4936
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 11, 2023 through Jul 11, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY15294 | CA | MD | Clinical Psychologist |
| 15294 | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Live Better Psychotherapy, a Licensed Clinical Social Worker | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Psychologist
- La Jolla, CA
- NPI 1124765375
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1646438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646438400000",
"number": "1932856341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6615 CANYON RIM ROW UNIT 153",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921117441",
"telephone_number": "858-245-4936"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5998 ALCALA PARK",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921108001",
"telephone_number": "858-245-4936"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ICHIYAMA",
"first_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-03-05",
"last_updated": "2022-03-05",
"certification_date": "2021-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY15294",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.