Healthcare Provider Details

I. General information

NPI: 1013215219
Provider Name (Legal Business Name): JENNIFER RHEE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2011
Last Update Date: 12/03/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6340 IRVINE BLVD
IRVINE CA
92620-2102
US

IV. Provider business mailing address

PO BOX 15787
NEWPORT BEACH CA
92659-5787
US

V. Phone/Fax

Practice location:
  • Phone: 949-559-6500
  • Fax:
Mailing address:
  • Phone: 949-559-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A11179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: