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DR. MICHAEL ICHIYAMA PH.D.
NPI 1932856341
Psychologist - Clinical in San Diego, CA

Active since March 05, 2022Opted out of Medicare · through Jul 11, 2027
5998 ALCALA PARK, SAN DIEGO, CA 92110(858) 245-4936 Get Directions Write a Review

NPPES record last updated: March 5, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Michael Ichiyama Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. MICHAEL ICHIYAMA PH.D. (NPI 1932856341) is an individual clinical provider in San Diego, California, licensed in California (PSY15294) and active in the NPI registry since March 2022. He has opted out of Medicare through July 11, 2027.

NPPES Registry Identity

NPI1932856341
Entity TypeIndividualMale
Primary Taxonomy103TC0700X
Provider Legal NameDR. MICHAEL ICHIYAMACredential: PH.D.
Location Address5998 ALCALA PARKSan Diego, CA 92110-8001
Mailing Address6615 Canyon Rim Row Unit 153San Diego, CA 92111-7441 · (858) 245-4936
Phone(858) 245-4936
Sole ProprietorYes
Enumeration DateMarch 5, 2022
NPPES CertifiedApril 17, 2021
✔ NPI 1932856341 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
License✔ Licensed in CA · PSY15294
Definition
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
5998 ALCALA PARK, San Diego, CA 92110
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Michael Ichiyama Ph.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from July 11, 2023 through July 11, 2027.

Opt-Out Effective DateJuly 11, 2023
Opt-Out In Effect ThroughJuly 11, 2027Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. DANIEL MELARA BOCATC
Specialist/Technologist (Athletic Trainer)
5998 ALCALA PARK
SAN DIEGO, CA 92110
San Diego County (619) 260-8895
PATRICK LANGIT ATC
Specialist/Technologist, Other
5998 ALCALA PARK
SAN DIEGO, CA 92110
San Diego County (619) 260-8895
JUSTINE MUNSAYAC COLIFLORES ATC
Specialist/Technologist (Athletic Trainer)
5998 ALCALA PARK
SAN DIEGO, CA 92110
San Diego County (619) 260-8895
CASSANDRA MARIE FISHER
Counselor (Mental Health)
5998 ALCALA PARK
SAN DIEGO, CA 92110
San Diego County (619) 800-5119
NICOLE WHITE-MADOLORA
Specialist/Technologist (Athletic Trainer)
5998 ALCALA PARK
SAN DIEGO, CA 92110
San Diego County (619) 260-4600
MIGUEL ANGEL GARCIA SANCHEZ
Counselor (Mental Health)
5998 ALCALA PARK
SAN DIEGO, CA 92110
San Diego County (786) 575-4962
ELIZABETH JOY LEIF
Counselor
5998 ALCALA PARK
SAN DIEGO, CA 92110
San Diego County (916) 502-3766
MR. JOHN THOMAS KONIECZNY III RN, BSN, CEN
Student in an Organized Health Care Education/Training Program
5998 ALCALA PARK
SAN DIEGO, CA 92110
San Diego County (619) 260-4548

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Michael Ichiyama's NPI number?

The NPI number for Michael Ichiyama is 1932856341. It was assigned to this individual provider in the NPPES registry on March 5, 2022.

Where is Michael Ichiyama located?

Michael Ichiyama practices at 5998 Alcala Park, San Diego, CA 92110. The listed phone number is (858) 245-4936.

What is Michael Ichiyama's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Michael Ichiyama enrolled in Medicare?

No. Michael Ichiyama has opted out of Medicare through July 11, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Michael Ichiyama was last updated on March 5, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.