Provider Demographics
NPI:1093086662
Name:KENNETH K. RHEE, MD,PC
Entity Type:Organization
Organization Name:KENNETH K. RHEE, MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:RHEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-589-7762
Mailing Address - Street 1:277 WEST ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-5707
Mailing Address - Country:US
Mailing Address - Phone:860-589-7762
Mailing Address - Fax:860-589-8132
Practice Address - Street 1:277 WEST ST
Practice Address - Street 2:SUITE B
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5707
Practice Address - Country:US
Practice Address - Phone:860-589-7762
Practice Address - Fax:860-589-8132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031225207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001312256Medicaid
160001839Medicare PIN
CT001312256Medicaid