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

Kyoungsook Leah Park, AGACNP-BC

Individual provider Internal Medicine Physician · NPI 1396618054

Kyoungsook Leah Park, AGACNP-BC is a Nurse Practitioner in Salt Lake City, Utah. Qualified in 2025, 1 year ago. Licensed in Utah.

Years since qualifying
1
Licensed in
UT
In the registry since
2025
Specialties on file
2
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

2455 E Village Cir
Salt Lake City, UT 84108-2437
Phone: (443) 846-9647
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Acute Care Nurse Practitioner (primary) Taxonomy 363LA2100X · Licence 12512586-4405 (UT)
Internal Medicine Physician Taxonomy 207R00000X · Licence 12512586-4405 (UT)

Record details

NPI number1396618054
Entity typeIndividual (Type 1)
GenderFemale
Credentials AGACNP-BC
Sole proprietorNo
NPI enumeratedSeptember 27, 2025
Last updated in NPPESApril 7, 2026
Certification dateApril 7, 2026

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Accepts Medicare assignment Not indicated

Other providers in Salt Lake City