IndividualActive
Jae Park
NPI 1396407011 · Otolaryngology Physician · Detroit, MI
Jae Park is a Otolaryngology Physician provider in Detroit, MI (NPI 1396407011).
Provider details
- NPI number
- 1396407011
- Entity type
- Individual
- Primary specialty
- Otolaryngology PhysicianAllopathic & Osteopathic Physicians
- Sex
- Male
- Sole proprietor
- No
- License
- 4351048809 (MI)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Established profile(61/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
4 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
4100 John R St
Detroit, MI 48201-2013
Phone: (248) 854-4576
Street-level locationGet directions
Mailing address
1363 Dorothea Rd
Berkley, MI 48072-2148
Registry dates
- Enumerated
- 2021-10-11
- Last updated
- 2021-10-11
- Certified
- 2021-10-11
Frequently asked questions
- What is Jae Park's NPI number?
- Jae Park's National Provider Identifier (NPI) is 1396407011, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What is Jae Park's specialty?
- Jae Park is listed in the NPPES registry with a primary specialty of Otolaryngology Physician (Allopathic & Osteopathic Physicians).
- Where is Jae Park located?
- Jae Park's practice location on file with NPPES is 4100 John R St, Detroit, MI 48201-2013.
- What is Jae Park's phone number?
- The practice phone number listed in the NPPES registry for Jae Park is (248) 854-4576.
- Is Jae Park's NPI active?
- Yes — Jae Park's NPI (1396407011) is active in the NPPES registry as of the last update on 2021-10-11.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.