Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1629710694 Deactivated / Inactive NPI Female Practitioner

So Yeon Park

Psychologist • Riverton, UT

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, So Park has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date April 11, 2022
NPI Deactivation Date July 09, 2026
Total Practice Duration ~4 Years of Practice (2022 – 2026)

Professional Overview & Biography Verified Profile Summary

So Park was a registered Psychologist practicing in Riverton, UT. Throughout an active medical career spanning 4 years, So Park provided care at the practice location at 3723 W 12600 S until profile deactivation on 2026-07-09.

Practice Location & Contact Primary Location

Practice Address

3723 W 12600 S

Riverton, UT 840657295

Telephone 8012854543
Associated Practice Facility / Clinic
🏢 Ihc Health Services Inc Facility NPI 1053441238

Specialty Benchmarks & Practice Insights

Comparative analytics for Psychologist in Riverton, UT

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 17.8 Yrs
Regional Practice Density
1 Specialists

Practicing in Riverton, UT (447 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2026-08-03
Psychologist Primary Specialty

NUCC Taxonomy Code: 103T00000X

State License UT 14284686-2501

A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

12 Associated Practitioners
Mekenna Bermingham , APRN

Nurse Practitioner

NPI 1073243531

Advanced Practice Registered Nurse

NPI 1083849723

Doctor of Medicine (M.D.)

NPI 1164533071

Doctor of Medicine (M.D.)

NPI 1255793824

Doctor of Medicine (M.D.)

NPI 1316920770

Doctor of Medicine (M.D.)

NPI 1346817525

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

11 Historical Events
📍
Updated Practice Location August 03, 2026

Registered at 3723 W 12600 S, RIVERTON, UT 840657295 (Tel: 8012854543)

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Updated Business Mailing Address August 03, 2026

Registered at PO BOX 27128, SALT LAKE CITY, UT 841270128

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Provider Name / Credentials Updated August 03, 2026

Recorded as SO PARK

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Medical Taxonomy / Specialty Registered (Primary Specialty) August 03, 2026

Psychologist (License #14284686-2501 in UT)

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NPI Profile Deactivated July 09, 2026

Record deactivated on July 09, 2026

NPI Profile Active April 11, 2022

NPI status registered as active in NPPES database

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Updated Practice Location April 11, 2022

Registered at 2401 GILLHAM RD, KANSAS CITY, MO 641084619 (Tel: 8162343000)

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Updated Business Mailing Address April 11, 2022

Registered at 2401 GILLHAM RD, KANSAS CITY, MO 641084619 (Tel: 8162343000)

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Provider Name / Credentials Updated April 11, 2022

Recorded as SO PARK

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Medical Taxonomy / Specialty Registered (Primary Specialty) April 11, 2022

Student in an Organized Health Care Education/Training Program

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Initial NPI Registration & Enumeration April 11, 2022

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1629710694
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: April 11, 2022
Last Update: August 03, 2026
Deactivation Date: July 09, 2026
Sole Proprietor: No

Mailing Address

Po Box 27128

Salt Lake City, UT 841270128

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.