Healthcare Provider Details

I. General information

NPI: 1225316151
Provider Name (Legal Business Name): JAYNE ELISA RHEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAYNE ELISA RHEE MD

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2071 SAN JOAQUIN HILLS RD
NEWPORT BEACH CA
92660-6505
US

IV. Provider business mailing address

24422 AVENIDA DE LA CARLOTA STE 300
LAGUNA HILLS CA
92653-3628
US

V. Phone/Fax

Practice location:
  • Phone: 949-759-1720
  • Fax: 949-759-1442
Mailing address:
  • Phone: 949-599-2423
  • Fax: 949-599-2430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG67067
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: