Basic Information
| Provider Information | |||||||||
| NPI: | 1659432409 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JRHEEM.D. A PROFESSIONAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5333 | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905105333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103292469 | ||||||||
| FaxNumber: | 3103290176 | ||||||||
| Practice Location | |||||||||
| Address1: | 3545 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900102354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134931744 | ||||||||
| FaxNumber: | 3103290176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 11/02/2009 | ||||||||
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| AuthorizedOfficialLastName: | RHEE | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3103292469 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | A92345 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
No ID Information.