Provider Demographics
NPI:1922041938
Name:RHEE, BENJAMIN KEONBOH (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:KEONBOH
Last Name:RHEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 COOK AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2911
Mailing Address - Country:US
Mailing Address - Phone:321-843-9017
Mailing Address - Fax:321-843-9019
Practice Address - Street 1:1725 COOK AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2911
Practice Address - Country:US
Practice Address - Phone:321-843-9017
Practice Address - Fax:321-843-9019
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN40599208800000X
CAG76342208800000X
IL036120805208800000X
FLME1411352088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN871222100Medicaid
FL103559500Medicaid
G82768Medicare UPIN