Provider Demographics
NPI:1235207614
Name:RHEE, TAE RYANG (MD)
Entity Type:Individual
Prefix:DR
First Name:TAE
Middle Name:RYANG
Last Name:RHEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:R
Other - Last Name:RHEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12555 GARDEN GROVE BLVD STE 408
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1904
Mailing Address - Country:US
Mailing Address - Phone:714-530-1010
Mailing Address - Fax:
Practice Address - Street 1:12555 GARDEN GROVE BLVD STE 408
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1904
Practice Address - Country:US
Practice Address - Phone:714-530-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26795174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A267951Medicaid
CAA83440Medicare UPIN
CAA26795AMedicare PIN