Individual
JIN S PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10123 SE MARKET ST, PORTLAND, OR 97216-2532
(503) 261-6985
(503) 261-6790
Mailing address
PO BOX 92900, PORTLAND, OR 97292-0900
(503) 261-6985
(503) 261-6790
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD23152
OR
208M00000X
Hospitalist Physician
Primary
MD23152
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
287437
—
OR
05
—
8292310
—
WA
Enumeration date
04/20/2006
Last updated
12/07/2017
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