Healthcare Provider Details

I. General information

NPI: 1487894473
Provider Name (Legal Business Name): RENAISSANCE PLASTIC RECONSTRUCTIVE AESTHETIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 03/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 HOSPITAL RD SUITE 218
NEWPORT BEACH CA
92663-3509
US

IV. Provider business mailing address

351 HOSPITAL RD SUITE 218
NEWPORT BEACH CA
92663-3509
US

V. Phone/Fax

Practice location:
  • Phone: 949-548-9312
  • Fax: 949-548-9623
Mailing address:
  • Phone: 949-548-9312
  • Fax: 949-548-9623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA81552
License Number StateCA

VIII. Authorized Official

Name: DR. RICHARD HEE-JIN LEE
Title or Position: OWNER
Credential: M.D.
Phone: 949-548-9312