Basic Information
| Provider Information | |||||||||
| NPI: | 1225316151 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RHEE | ||||||||
| FirstName: | JAYNE | ||||||||
| MiddleName: | ELISA | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | RHEE | ||||||||
| OtherFirstName: | JAYNE | ||||||||
| OtherMiddleName: | ELISA | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 24422 AVENIDA DE LA CARLOTA STE 300 | ||||||||
| Address2: | |||||||||
| City: | LAGUNA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926533628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495992423 | ||||||||
| FaxNumber: | 9495992430 | ||||||||
| Practice Location | |||||||||
| Address1: | 2071 SAN JOAQUIN HILLS RD | ||||||||
| Address2: | |||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926606505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9497591720 | ||||||||
| FaxNumber: | 9497591442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2011 | ||||||||
| LastUpdateDate: | 03/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | G67067 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.