Kyoungsook Leah Park, AGACNP-BC - Medicare Nurse Practitioner in Salt Lake City, UT

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Kyoungsook Leah Park, AGACNP-BC is a medicare enrolled "Nurse Practitioner - Acute Care" physician in Salt Lake City, Utah. She graduated from medical school in 2025 and has 1 years of diverse experience with area of expertise as Nurse Practitioner. Her current practice location is 2455 E Village Cir, Salt Lake City, Utah. You can reach out to her office (for appointments etc.) via phone at (443) 846-9647.

Kyoungsook Leah Park is licensed to practice in Utah (license number 12512586-4405) and she also participates in the medicare program. She may accept medicare assignments (which means she may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance) and her NPI Number is 1396618054.

Contact Information

Kyoungsook Leah Park, AGACNP-BC
2455 E Village Cir,
Salt Lake City, UT 84108-2437
(443) 846-9647
Not Available

Map and Direction




Physician's Profile

Full NameKyoungsook Leah Park
GenderFemale
SpecialityNurse Practitioner
Experience1 Years
Location2455 E Village Cir, Salt Lake City, Utah
Accepts Medicare AssignmentsMay be. She may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Kyoungsook Leah Park graduated from medical school in 2025
  NPI Data:
  • NPI Number: 1396618054
  • Provider Enumeration Date: 09/27/2025
  • Last Update Date: 04/07/2026
  Medicare PECOS Information:
  • PECOS PAC ID: 4587130117
  • Enrollment ID: I20260420003390

Medical Identifiers

Medical identifiers for Kyoungsook Leah Park such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1396618054NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207R00000XInternal Medicine 12512586-4405 (Utah)Secondary
363LA2100XNurse Practitioner - Acute Care 12512586-4405 (Utah)Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kyoungsook Leah Park is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Kyoungsook Leah Park, AGACNP-BC
2455 E Village Cir,
Salt Lake City, UT 84108-2437

Ph: (443) 846-9647		Kyoungsook Leah Park, AGACNP-BC
2455 E Village Cir,
Salt Lake City, UT 84108-2437

Ph: (443) 846-9647

Reviews and Comments



Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.