Kyoungsook Leah Park, AGACNP-BC

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

12512586-4405 Issued in UT

Practice address

2455 E Village Cir
Salt Lake City, UT 84108-2437

Phone

(443) 846-9647

NPI assigned

Sep 27, 2025

Last updated

Apr 7, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2025

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• University of Utah Acuity Care Services

  dba Anesthesiology Dept SICU

  • Critical Care Medicine (Anesthesiology) Physician
  • Salt Lake City, UT
  • NPI 1407250541
  Medicare reassignment

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

{
    "created_epoch": "1758931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775520000000",
    "number": "1396618054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2455 E VILLAGE CIR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841082437",
            "telephone_number": "443-846-9647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2455 E VILLAGE CIR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841082437",
            "telephone_number": "443-846-9647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "KYOUNGSOOK",
        "middle_name": "LEAH",
        "credential": "AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-09-27",
        "last_updated": "2026-04-07",
        "certification_date": "2026-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "UT",
            "license": "12512586-4405",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "UT",
            "license": "12512586-4405",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandon Birg Park, M.D.
• Brittney Marie Park
• Chihyung Park, MBBS
• Gordon Sherman Park, MD
• Howard Y. Park, MD
• Madeline Park, DNP, APRN
• Marci Park, R.N.
• Minji Park, DNP, NP-C
• Morgan Park, DDS
• Sunho Park

• Acute Care Nurse Practitioner in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Acute Care Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.