Healthcare Provider Details

I. General information

NPI: 1073784492
Provider Name (Legal Business Name): SOO SHIN RHEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 STONERIDGE MALL RD SUITE 101
PLEASANTON CA
94588-3274
US

IV. Provider business mailing address

DEPT 34929 P.O. BOX 39000
SAN FRANCISCO CA
94139-0001
US

V. Phone/Fax

Practice location:
  • Phone: 925-224-0720
  • Fax: 925-224-0722
Mailing address:
  • Phone: 925-952-2828
  • Fax: 925-952-2850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA115444
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number44402
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: