Provider Demographics
NPI:1477010858
Name:BEACH FOOT AND ANKLE CENTER INC
Entity Type:Organization
Organization Name:BEACH FOOT AND ANKLE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:SONG WOO
Authorized Official - Last Name:RHEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:714-522-8000
Mailing Address - Street 1:5832 BEACH BLVD UNIT 211
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-5501
Mailing Address - Country:US
Mailing Address - Phone:714-522-8000
Mailing Address - Fax:714-522-8008
Practice Address - Street 1:5832 BEACH BLVD UNIT 211
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-5501
Practice Address - Country:US
Practice Address - Phone:714-522-8000
Practice Address - Fax:714-522-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-21
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABL-030293OtherBUSINESS LICENSE