Kaitlyn Min Park, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95010268 Issued in CA

Practice address

625 S Fair Oaks Ave Ste 215
Pasadena, CA 91105-2613

Phone

(626) 793-4139

Fax

(626) 304-8280

NPI assigned

Mar 14, 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

Other names 1

• Kaitlyn J Min Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1552521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609804800000",
    "number": "1932668423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3452 E FOOTHILL BLVD STE 130",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911076006",
            "telephone_number": "626-793-2885",
            "fax_number": "626-793-6262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 S FAIR OAKS AVE STE 215",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911052613",
            "telephone_number": "626-793-4139",
            "fax_number": "626-304-8280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "KAITLYN",
        "middle_name": "MIN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-14",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95010268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAITLYN",
            "last_name": "MIN",
            "middle_name": "J",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Hyejin Park, MA
• Jasmine Myso Park, MD
• Jean Yunjin Park
• Jennifer Y Park, M.D.
• Jinha Mark Park, M.D., PH.D.
• Kara Faith Heeyoung Park, LMFT
• Kristoffer Park
• Kwang Hee Park, L.AC
• Margaret Park, OTR/L
• Phillip S.H Park, DDS

• Family Nurse Practitioner in Pasadena, CA
• Providers in Pasadena, 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 Jan 5, 2021; 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.