Kelly Park

Primary specialty

Social WorkerTaxonomy code 104100000X

License

SC61520989 Issued in WA

Practice address

2100 24TH Ave S # 205
Seattle, WA 98144-4637

Phone

(206) 382-5340

NPI assigned

Jan 25, 2022

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1643068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748390400000",
    "number": "1801548417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 24TH AVE S # 205",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981444637",
            "telephone_number": "206-382-5340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 24TH AVE S # 205",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981444637",
            "telephone_number": "206-382-5340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "KELLY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-25",
        "last_updated": "2025-05-28",
        "certification_date": "2025-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WA",
            "license": "SC61520989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Sewook Park, RRT
• Jonathan Park, PHARM D.
• Juengsun Park, PHARMD
• Jung Sun Park
• Kathleen J Park, MD
• Lala Park, MD
• Lisa Wysong Park, DDS
• Louise M Park, ARNP
• Luke C. Park, D.D.S.
• Marian Park, MD

• Social Worker in Seattle, WA
• Providers in Seattle, WA by specialty
• Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.