Kelly Park, MD
Psychiatry & Neurology, Psychiatry in Los Angeles, CA. Individual provider (NPI-1).
NPI number1669934659
StatusActive
Last updated in NPPESMar 14, 2025
Details
- NPI
- 1669934659
- Entity type
- Individual (NPI-1)
- Name
- Kelly Park
- Credential
- MD
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 1, 2019
- Certification date
- Mar 14, 2025
- Last updated
- Mar 14, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology, Psychiatry | A176127 | CA | Yes |
Practice location
222 S Hill St Fl 5Los Angeles, CA 90012-3508
Phone 213-518-2074
Mailing address
2527 Farview RdFullerton, CA 92833-1519
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