Active NPI
Jin Park
- Oral and Maxillofacial Surgery (Dentist)
- Salem, OR
National Provider Identifier
1801246715
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- D12135
- Practice address
- 250 Church St SE Ste 102
Salem, OR 97301-3758 - Phone
- (503) 581-1999
- NPI assigned
- Jun 21, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | D12135 | OR | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
250 Church St SE Ste 102
Salem, OR 97301-3758
Mailing address
250 Church St SE Ste 102
Salem, OR 97301-3758
Other practice location 1
1 Medical Center Dr
Morgantown, WV 26506-1200
Phone (304) 293-2841
Other practice location 2
507 W Stan Schlueter Loop Ste 400
Killeen, TX 76542-6877
Phone (254) 870-9209
Other practice location 3
1400 Pelham Pkwy S
Bronx, NY 10461-1138
Phone (719) 918-3419
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39421 | TX | MD | Oral and Maxillofacial Surgery (Dentist) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1466467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783987200000",
"number": "1801246715",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 CHURCH ST SE STE 102",
"city": "SALEM",
"state": "OR",
"postal_code": "973013758"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 CHURCH ST SE STE 102",
"city": "SALEM",
"state": "OR",
"postal_code": "973013758",
"telephone_number": "503-581-1999"
}
],
"practiceLocations": [
{
"address_1": "1 Medical Center Dr",
"address_purpose": "LOCATION",
"city": "Morgantown",
"state": "WV",
"postal_code": "265061200",
"country_code": "US",
"telephone_number": "304-293-2841",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "507 W Stan Schlueter Loop Ste 400",
"address_purpose": "LOCATION",
"city": "Killeen",
"state": "TX",
"postal_code": "765426877",
"country_code": "US",
"telephone_number": "254-870-9209",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1400 Pelham Pkwy S",
"address_purpose": "LOCATION",
"city": "Bronx",
"state": "NY",
"postal_code": "104611138",
"country_code": "US",
"telephone_number": "719-918-3419",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PARK",
"first_name": "JIN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-06-21",
"last_updated": "2026-07-14",
"certification_date": "2026-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "OR",
"license": "D12135",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.