=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265497846
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENNETH J RHEE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2006
-----------------------------------------------------
Last Update Date | 05/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 S PARADISE AVE
-----------------------------------------------------
City | MIDDLETON
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83644-5809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-585-0048
-----------------------------------------------------
Fax | 208-466-5359
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9
-----------------------------------------------------
City | NAMPA
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83653-0009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-467-4431
-----------------------------------------------------
Fax | 208-466-5359
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD21220
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 6161371
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------