Healthcare Provider Details

I. General information

NPI: 1770799314
Provider Name (Legal Business Name): JASON YOUNG RHEE M.D., M.P.H.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD STE 297A
SAINT LOUIS MO
63141-8200
US

IV. Provider business mailing address

621 S NEW BALLAS RD STE 297A
SAINT LOUIS MO
63141-8200
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6364
  • Fax: 314-251-7897
Mailing address:
  • Phone: 314-251-6364
  • Fax: 314-251-7897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2012004001
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number2012004001
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: