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KYOUNGSOOK LEAH PARK AGACNP-BC
NPI 1396618054
Nurse Practitioner - Acute Care in Salt Lake City, UT

Active since September 27, 2025PECOS Enrolled
2455 E VILLAGE CIR, SALT LAKE CITY, UT 84108(443) 846-9647 Get Directions Write a Review

NPPES record last updated: April 7, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Kyoungsook Leah Park Agacnp-bc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KYOUNGSOOK LEAH PARK AGACNP-BC (NPI 1396618054) is an individual acute care provider in Salt Lake City, Utah, licensed in Utah (12512586-4405) and active in the NPI registry since September 2025. She is enrolled in Medicare PECOS and is a graduate of Other (2025).

NPPES Registry Identity

NPI1396618054
Entity TypeIndividualFemale
Primary Taxonomy363LA2100X
Provider Legal NameKYOUNGSOOK LEAH PARKCredential: AGACNP-BC
Location Address2455 E VILLAGE CIRSalt Lake City, UT 84108-2437
Mailing Address2455 E Village CirSalt Lake City, UT 84108-2437 · (443) 846-9647
Phone(443) 846-9647
Sole ProprietorNo
Medical School CMSOtherGraduated 2025
Enumeration DateSeptember 27, 2025
Last NPPES UpdateApril 7, 2026
NPPES CertifiedApril 7, 2026
✔ NPI 1396618054 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Acute CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2100X
License✔ Licensed in UT · 12512586-4405
Also ListedInternal MedicineTaxonomy 207R00000X · License 12512586-4405 (UT)
2455 E VILLAGE CIR, Salt Lake City, UT 84108
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kyoungsook Leah Park Agacnp-bc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID4587130117
PECOS Enrollment IDI20260420003390
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Kyoungsook Park reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

University Of Utah Acuity Care Services
1.1 mi
Neuromuscular Medicine
501 S CHIPETA WAY
Salt Lake City, UT 84108
  • Reassigned Medicare billing, Utah enrollment
  • 338 clinicians in this Medicare group
NPI 1366804254 (801) 587-6336

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84108 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.41 typical visit price
range $54.34 – $166.03
Typical copayment $21.10 (range $13.58 – $41.50)
Most-billed visit code 99203
Established Patient
$96.35 typical visit price
range $17.23 – $135.20
Typical copayment $24.08 (range $4.30 – $33.80)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kyoungsook Park's NPI number?

The NPI number for Kyoungsook Park is 1396618054. It was assigned to this individual provider in the NPPES registry on September 27, 2025.

Where is Kyoungsook Park located?

Kyoungsook Park practices at 2455 E Village Cir, Salt Lake City, UT 84108. The listed phone number is (443) 846-9647.

What is Kyoungsook Park's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Acute Care, with taxonomy code 363LA2100X.

Is Kyoungsook Park enrolled in Medicare?

Yes. Kyoungsook Park is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Kyoungsook Park's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kyoungsook Park reassigns Medicare benefits to University Of Utah Acuity Care Services (Salt Lake City, UT). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kyoungsook Park's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Kyoungsook Park was last updated on April 7, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.