Provider Demographics
NPI:1265559140
Name:MCRAE, DEENA (MD)
Entity type:Individual
Prefix:DR
First Name:DEENA
Middle Name:
Last Name:MCRAE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEENA
Other - Middle Name:SHIN
Other - Last Name:MCRAE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:18301 VON KARMAN AVE
Mailing Address - Street 2:SUITE 880
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1009
Mailing Address - Country:US
Mailing Address - Phone:949-340-3570
Mailing Address - Fax:949-200-7089
Practice Address - Street 1:18301 VON KARMAN AVE
Practice Address - Street 2:SUITE 880
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1009
Practice Address - Country:US
Practice Address - Phone:949-340-3570
Practice Address - Fax:949-200-7089
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA821182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry