JAE O PARK (NPI# 1780621805) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780621805 |
| Entity Type | Individual |
| Full Name | JAE O PARK |
| Credential | MD |
| Practice Address |
14455 Sw Allen Blvd Suite 101 Beaverton OR 97005-4428 |
| Mailing Address |
12750 Sw 2nd St Ste 101 Beaverton OR 97005-2779 |
| Practice Telephone | 5036432120 |
| Practice Fax Number | 5036431034 |
| Mailing Telephone | 5036432120 |
| Mailing Fax Number | 5036431034 |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2017-02-24 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | MD13752 | OR | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386110781 | Jae H Park | Dentist | 1637 Admiral Taussig Blvd, Norfolk, VA 23511-2803 | 2018-10-23 |
| 1720506314 | Jae Y Park | Registered Nurse | 1103 10th St Nw, Rochester, MN 55901-1756 | 2017-09-02 |
| 1861649881 | Jae Hyun Park | Acupuncturist | 3020 Wilshire Blvd Ste 222, Los Angeles, CA 90010 | 2008-08-20 |
| 1811065238 | Jae Hyun Park | Dentist | 3155 W Indian School Rd, Western Dental Orthodontic Office, Phoenix, AZ 85017-4035 | 2006-12-01 |
| 1700977543 | Jae Ho Park | Dentist | 3123 W Olympic Blvd, Los Angeles, CA 90006-2462 | 2006-09-27 |
| 1144329723 | Jae H Park | Chiropractor | 4840 Irvine Blvd, #203, Irvine, CA 92620-1962 | 2006-09-21 |
| 1699750182 | Jae Y Park | Pharmacist | 3307 W Pico Bl, Los Angeles, CA 90019-4530 | 2005-12-07 |
| 1285109504 | Jae Park | Acupuncturist | 320 Ward Ave Ste 205, Honolulu, HI 96814-4017 | 2018-10-12 |
| 1336649573 | Jae Hong Park | Dentist | 1400 Pelham Pkwy S, Bronx, NY 10461-1138 | 2018-02-14 |
| 1750819652 | Jae Ho Park Sr. | Pharmacist | 254 N Western Ave, Los Angeles, CA 90004-4108 | 2017-05-23 |
| Street Address |
14455 SW ALLEN BLVD SUITE 101 |
| City | BEAVERTON |
| State | OR |
| Zip Code | 97005-4428 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245640572 | Amany Bashir | Family Medicine | 14455 Sw Allen Blvd, Ste 100, Beaverton, OR 97005-4428 | 2014-05-08 |
| 1730391087 | Esther C Oh | Denturist | 14455 Sw Allen Blvd, Beaverton, OR 97005-4428 | 2007-05-07 |
| 1386862928 | Andrei M Mihailescu | Dentist | 14455 Sw Allen Blvd, Suite 103, Beaverton, OR 97005-4428 | 2007-04-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154945053 | Krista Lowe Schimmelbusch | Student in an Organized Health Care Education/Training Program | 12730 Sw 3rd St., Beaverton, OR 97005 | 2020-06-05 |
| 1346882578 | Mireya Elissa Nunez I | Counselor | 12665 Sw Center Street, Suite 100, Beaverton, OR 97005 | 2019-10-09 |
| 1548816879 | Logan James Patzlaff | Behavior Technician | 6200 Sw Artic Drive Beaverton, Or 97005, Beaverton, OR 97005 | 2019-08-13 |
| 1528521424 | Alex Taylor Foerman | Behavior Technician | 6200 Sw Arctic Drive Beaverton, Or 97005, Beaverton, OR 97005 | 2019-04-09 |
| 1285193003 | Hazelnut Dental LLC | Clinic/Center | 10773 Sw Beaverton-hillsdale Hwy, Ste B, Beaverton, OR 97005 | 2019-03-19 |
| 1992286348 | Kathryn Wallner | Counselor | 14205 Sw Farmington Road, Suite 160, Beaverton, OR 97005 | 2018-08-23 |
| 1699265058 | Meaghan Mikulic | Social Worker | 14355 Sw Allen Blvd Suite 150, Beaverton, OR 97005 | 2018-05-11 |
| 1629568936 | Aimee J Nelson | Massage Therapist | 10700 Sw Beaverton Hillsdale Hwy Ste 465, Beaverton, OR 97005 | 2018-05-11 |
| 1093221780 | Ember Dahl | Massage Therapist | 12655 Sw Center St Ste 530, Beaverton, OR 97005 | 2017-12-18 |
| 1033667456 | Andre Vo | Pharmacist | 2575 Sw Walker Rd, Beaverton, OR 97005 | 2016-09-14 |
| Find all providers in zip 97005 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497306468 | David P Larson, Md, LLC | Internal Medicine | 16043 Sw Waxwing Way, Beaverton, OR 97007-8362 | 2019-09-21 |
| 1639353378 | Mir Clinic, P.C. | Internal Medicine | 2155 Nw 173rd Ave Ste 102, Beaverton, OR 97006-3563 | 2007-12-18 |
| 1669697959 | John M. Rex Jr. | Internal Medicine | 8721 Sw 184th Dr, Beaverton, OR 97007-6865 | 2007-04-13 |
| 1518026962 | Lawrence Wayne Elzinga | Internal Medicine | 1920 Amberglen Pky, Suite 150 Fatigue and Fibromyalgia Center, Beaverton, OR 97006 | 2006-12-08 |
| 1225124639 | Sharon Louise Kenny | Internal Medicine | Beaverton Medical Office, 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2006-10-04 |
| 1053423400 | Chad T Pfefer | Internal Medicine | 1920 Nw Amberglen Pkwy, Ste 150, Beaverton, OR 97006-6977 | 2006-08-31 |
| 1831110964 | Thomas D Gilberts Md LLC | Internal Medicine | 17200 Nw Corridor Ct, Suite 105, Beaverton, OR 97006-3295 | 2006-07-22 |
| 1679509111 | Mehdi M Mirtorabi | Internal Medicine | 2155 Nw 173rd Ave, Suite 102, Beaverton, OR 97006-3563 | 2006-06-25 |
| 1033159074 | Christopher R Baldwin | Internal Medicine | 2225 Ne Town Center Dr, Beaverton, OR 97006-8915 | 2006-06-07 |
| 1932147600 | Internal Medicine Consultants PC | Internal Medicine | 14355 Sw Allen Blvd, 130, Beaverton, OR 97005-4700 | 2006-06-03 |
| Find all providers in BEAVERTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.