Provider Demographics
NPI:1205246113
Name:RHEEM, JUSTIN YOUNGBIN (MD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:YOUNGBIN
Last Name:RHEEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YOUNG
Other - Middle Name:
Other - Last Name:RHEEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 S VIRGIL AVE
Mailing Address - Street 2:STE 106
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1407
Mailing Address - Country:US
Mailing Address - Phone:213-381-3630
Mailing Address - Fax:213-674-7414
Practice Address - Street 1:505 S VIRGIL AVE
Practice Address - Street 2:STE 106
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1407
Practice Address - Country:US
Practice Address - Phone:213-381-3630
Practice Address - Fax:213-674-7414
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA137983207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty