Individual
KYOUNGSOOK LEAH PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
2455 E VILLAGE CIR, SALT LAKE CITY, UT 84108-2437
(443) 846-9647
Mailing address
2455 E VILLAGE CIR, SALT LAKE CITY, UT 84108-2437
(443) 846-9647
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
12512586-4405
UT
363LA2100X
Acute Care Nurse Practitioner
Primary
12512586-4405
UT
Other
Enumeration date
09/27/2025
Last updated
04/07/2026
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