Provider Demographics
NPI:1255584090
Name:RHEE, SOO J (MD)
Entity type:Individual
Prefix:DR
First Name:SOO
Middle Name:J
Last Name:RHEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E 68TH ST FL 7
Mailing Address - Street 2:BOX 197
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-4870
Mailing Address - Country:US
Mailing Address - Phone:212-746-5964
Mailing Address - Fax:
Practice Address - Street 1:525 E 68TH ST FL 7
Practice Address - Street 2:BOX 197
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-5964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238238208600000X, 2086S0129X
NY223869208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ44476OtherBLUE CROSS BLUE SHIELD
MA2166861Medicaid
MA498712OtherTUFTS
MAJ44476OtherBLUE CROSS BLUE SHIELD