Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kenneth Park, PA-C

Individual provider Physician Assistant · NPI 1194973768

Kenneth Park, PA-C is a Physician Assistant in Chicago, Illinois. Qualified in 2007, 19 years ago. Accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
19
Licensed in
IL
In the registry since
2008
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

3860 W Ogden Ave
Chicago, IL 60623-2460
Phone: (872) 588-3000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 085003022 (IL)

Record details

NPI number1194973768
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 8, 2008
Last updated in NPPESAugust 31, 2022
Certification dateAugust 31, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2007 (19 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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