Heidi Haewah Park, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

15190 Issued in CA

Practice address

11705 S. Alameda St.
Lynwood, CA 90262-4023

Phone

(323) 568-4545

NPI assigned

May 22, 2025

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1747872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747872000000",
    "number": "1891588992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 S PLYMOUTH BLVD UNIT 201",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900053892",
            "telephone_number": "818-279-1699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11705 S. ALAMEDA ST.",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "902624023",
            "telephone_number": "323-568-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "HEIDI",
        "middle_name": "HAEWAH",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-05-22",
        "last_updated": "2025-05-22",
        "certification_date": "2025-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "15190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ivy Janet Palencia Diaz
• Corinne Palma
• Palo Dialysis LLC
• Parid Pakravan Dental Corporation
• Daniel Won Park, PT, DPT
• Jea Young Park, L, AC
• Jeong Sun Park
• Joy Park, PA-C
• Ariel Parker
• Crystal Marie Parra

• Family Nurse Practitioner in Lynwood, CA
• Providers in Lynwood, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 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.