Provider Demographics
NPI:1376295501
Name:SUMMERSIDE HEALTH PLLC
Entity Type:Organization
Organization Name:SUMMERSIDE HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:KWAN
Authorized Official - Last Name:RHEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-859-9392
Mailing Address - Street 1:9225 TUDOR PARK PL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-8726
Mailing Address - Country:US
Mailing Address - Phone:312-859-9392
Mailing Address - Fax:
Practice Address - Street 1:1555 RAMAR RD
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-6010
Practice Address - Country:US
Practice Address - Phone:702-960-6930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty