Kelly Kyunghwa Park (NPI# 1659683993, PAC ID# 9830499417) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is DERMATOLOGY.
| Nation Provider ID (NPI) | 1659683993 |
| PAC ID by PECOS | 9830499417 |
| Professional Enrollment ID | I20170627001862 |
| Full Name | Kelly Kyunghwa Park |
| Organization Legal Name | LAKESIDE DERMATOLOGY |
| Address |
1425 N Hunt Club Rd Suite 202 Gurnee IL 60031-2635 |
| Phone Number | 8478551730 |
| Gender | F |
| Medical School | NORTHEASTERN OHIO UNIVERSITIES COLLEGE OF MEDICINE |
| Graduation Year | 2009 |
| Primary Specialty | DERMATOLOGY |
| Group Practice PAC ID | 6800107459 |
| Number of Group Practice Members | 4 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 1425 N Hunt Club Rd, Suite 202, Gurnee, IL 60031-2635 | 8478551730 | LAKESIDE DERMATOLOGY |
| 1240 N Milwaukee Ave, Libertyville, IL 60048-1307 | 8473675575 | LAKESIDE DERMATOLOGY |
| Organization Legal Name | LAKESIDE DERMATOLOGY |
| Physicians | 4 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Martha Arroyo | Dermatology | Lakeside Dermatology | 1240 N Milwaukee Ave, Libertyville, IL 60048-1307 |
| Allyssa Jean Clapsaddle | Physician Assistant | Lakeside Dermatology | 1240 N Milwaukee Ave, Libertyville, IL 60048-1307 |
| Kelly J Boyle | Physician Assistant | Lakeside Dermatology | 755 S Milwaukee Ave, Suite 224, Libertyville, IL 60048-3266 |
| Street Address |
1425 N HUNT CLUB RD SUITE 202 |
| City | GURNEE |
| State | IL |
| Zip | 60031-2635 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Luis I Salazar | Family Medicine | Provida Health Center Sc | 1425 N Hunt Club Rd, Suite 100, Gurnee, IL 60031-2632 |
| Caitlin M Chandran | Nurse Practitioner | Provida Health Center Sc | 1425 N Hunt Club Rd, Suite 100, Gurnee, IL 60031-2632 |
| Monica Haydee Gonzalez | Registered Dietitian Or Nutrition Professional | Provida Health Center Sc | 1425 N Hunt Club Rd, Suite 100, Gurnee, IL 60031-2632 |
| Ksenia Samvel | Physician Assistant | Provida Health Center Sc | 1425 N Hunt Club Rd, Suite 100, Gurnee, IL 60031-2632 |
| Rosalva Acosta | Physician Assistant | Provida Health Center Sc | 1425 N Hunt Club Rd, Suite 100, Gurnee, IL 60031-2632 |
| Ira J Piel | Hematology/oncology | Ira J Piel Md Facp Sc | 1425 N Hunt Club Rd, Gurnee, IL 60031-2639 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Amanda J Caplan | Family Medicine | Northshore University Healthsystem Faculty Practice Associates | 7900 Rollins Rd, Gurnee, IL 60031-1512 |
| Rebecca E Jacobson | Obstetrics/gynecology | Northshore University Healthsystem Faculty Practice Associates | 7900 Rollins Rd, Gurnee, IL 60031-1512 |
| Lauren E Rosen | Nurse Practitioner | Northshore University Healthsystem Faculty Practice Associates | 7900 Rollins Rd, Gurnee, IL 60031-1512 |
| Esther Y Liu | Family Medicine | Northshore University Healthsystem Faculty Practice Associates | 7900 Rollins Rd, Gurnee, IL 60031-1512 |
| Erik B Pauls | Physician Assistant | Northshore University Healthsystem Faculty Practice Associates | 7900 Rollins Rd, Gurnee, IL 60031-1512 |
| Smitha K. John | Nurse Practitioner | Northshore University Healthsystem Faculty Practice Associates | 7900 Rollins Rd, Gurnee, IL 60031-1512 |
| Brenda Y Kim | Obstetrics/gynecology | Northshore University Healthsystem Faculty Practice Associates | 7900 Rollins Rd, Gurnee, IL 60031-1512 |
| Rajiv K Udani | Hospitalist | Northshore University Healthsystem Faculty Practice Associates | 7900 Rollins Rd, Gurnee, IL 60031-1512 |
| Nancy A Nora | Nephrology | Northshore University Healthsystem Faculty Practice Associates | 7900 Rollins Rd, Gurnee, IL 60031-1512 |
| Therese A Hughes | Obstetrics/gynecology | Northshore University Healthsystem Faculty Practice Associates | 7900 Rollins Rd, Gurnee, IL 60031-1512 |
| Find all physicians in zip 60031 | |||
| City | GURNEE |
| Zip Code | 60031 |
| Specialty | DERMATOLOGY |
| City + Specialty | GURNEE + DERMATOLOGY |
Please comment or provide details below to improve the information on Kelly Kyunghwa Park.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.