Kelly Park, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

A176127 Issued in CA

Practice address

222 S Hill St FL 5
Los Angeles, CA 90012-3508

Phone

(213) 518-2074

NPI assigned

Apr 1, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Gateways Hospital & Mental Health Center

  • Psychiatric Hospital
  • Los Angeles, CA
  • NPI 1720151137
  Medicare reassignment NPD
• Gateways Hospital & Mental Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Los Angeles, CA
  • NPI 1497884613
  NPD

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

{
    "created_epoch": "1554076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741910400000",
    "number": "1669934659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2527 FARVIEW RD",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928331519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 S HILL ST FL 5",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900123508",
            "telephone_number": "213-518-2074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "KELLY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-01",
        "last_updated": "2025-03-14",
        "certification_date": "2025-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A176127",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Lynn Park, MA, OTR/L, SWC
• Katherine Park, IPA
• Katherine H Park, OTR/L
• Kathy Won Park, N.P.
• Keeyong Park, MD
• Kendrick Park
• Kenneth Park, MD
• Kerry Park, M.D.
• Kevin Park, DDS
• Kihyun Park

• Psychiatry Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.