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General NPI Number Information
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NPI Number | 1487894473
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Entity Type | Organization
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Legal Business Name | RENAISSANCE PLASTIC RECONSTRUCTIVE AESTHETIC SURGERY
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Dates
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Enumeration Date | 03/03/2009
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Last Update Date | 03/03/2009
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Provider Practice Location Address
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Address Line | 351 HOSPITAL RD SUITE 218
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3509
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Country | US
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Telephone | 949-548-9312
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Fax | 949-548-9623
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Provider Business Mailing Address
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Address Line | 351 HOSPITAL RD SUITE 218
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3509
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Country | US
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Telephone | 949-548-9312
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Fax | 949-548-9623
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD HEE-JIN LEE
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Credential | M.D.
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Telephone | 949-548-9312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A81552
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License Number State | CA
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