Individual provider Active NPI

Grahamm Wiest, PSY.D.

  • Clinical Neuropsychologist
  • Mission Viejo, CA
National Provider Identifier
1962015628
Registry record updated Jul 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
34353 Issued in CA
Practice address
26800 Crown Valley Pkwy Ste 320
Mission Viejo, CA 92691-7320
Phone
(949) 365-2468
NPI assigned
Aug 24, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X CA
Clinical Neuropsychologist 103G00000X 34353 CA Primary

Addresses

Primary practice location

26800 Crown Valley Pkwy Ste 320
Mission Viejo, CA 92691-7320

Mailing address

505 N Euclid St Ste 300
Anaheim, CA 92801-5514
Phone (714) 871-5646

Other practice location 1

1110 E Chapman Ave Ste 202
Orange, CA 92866-2139
Phone (714) 744-9754

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20250729004785 CA Practitioner - Neuropsychiatry 3375050719 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neuropsychiatry
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

26800 Crown Valley Pkwy
Suite 320
Mission Viejo, CA 92691-7320
Phone (949) 542-8002

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34353CAMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation CurrentSince Aug 1, 2025 Accepting new patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation CurrentSince Aug 1, 2025 Accepting new patients
Western Youth Services PastSince Aug 1, 2020 Accepting new patients

Locations

200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841

1950 Sunny Crest Dr
Ste 2900
Fullerton, CA 92835

100 E Valencia Mesa Dr
Ste 105
Fullerton, CA 92835
Phone (714) 446-5200

26800 Crown Valley Pkwy
Ste 320
Mission Viejo, CA 92691
Phone (949) 276-8900

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1598227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752537600000",
    "number": "1962015628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 N EUCLID ST STE 300",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928015514",
            "telephone_number": "714-871-5646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26800 CROWN VALLEY PKWY STE 320",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926917320",
            "telephone_number": "949-365-2468"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1110 E Chapman Ave Ste 202",
            "address_purpose": "LOCATION",
            "city": "Orange",
            "state": "CA",
            "postal_code": "928662139",
            "country_code": "US",
            "telephone_number": "714-744-9754",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIEST",
        "first_name": "GRAHAMM",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-24",
        "last_updated": "2025-07-15",
        "certification_date": "2025-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "34353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mission Viejo, CA

Sources for this page

Verify at the official NPI Registry.