Individual
JAE O PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14455 SW ALLEN BLVD, SUITE 101, BEAVERTON, OR 97005-4428
(503) 643-2120
(503) 643-1034
Mailing address
12750 SW 2ND ST, STE 101, BEAVERTON, OR 97005-2779
(503) 643-2120
(503) 643-1034
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD13752
OR
Other
Enumeration date
05/31/2006
Last updated
02/24/2017
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