Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jae O Park, MD

Individual provider Internal Medicine Physician · NPI 1780621805

Jae O Park, MD is an Internal Medicine in Beaverton, Oregon. Qualified in 1969, 57 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in Oregon.

Years since qualifying
57
Licensed in
OR
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

14455 SW Allen Blvd Ste 101
Beaverton, OR 97005-4428
Phone: (503) 643-2120
Fax: (503) 643-1034
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence MD13752 (OR)

Record details

NPI number1780621805
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedMay 31, 2006
Last updated in NPPESFebruary 24, 2017
Mailing address12750 Sw 2nd St, Ste 101, Beaverton, OR 97005-2779

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyINTERNAL MEDICINE
Medical schoolOTHER
Graduated 1969 (57 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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