1104823749 NPI number — MR. JAMES TAE SUK RHYEE MD

Table of content: MR. JAMES TAE SUK RHYEE MD (NPI 1104823749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104823749 NPI number — MR. JAMES TAE SUK RHYEE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RHYEE
Provider First Name:
JAMES
Provider Middle Name:
TAE SUK
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RHYEE
Provider Other First Name:
TAE
Provider Other Middle Name:
SUK
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104823749
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5039 VILLA LINDE PKWY
Provider Second Line Business Mailing Address:
STE 30
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48532-3450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-732-8451
Provider Business Mailing Address Fax Number:
810-732-8980

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5039 VILLA LINDE PKWY
Provider Second Line Business Practice Location Address:
STE 30
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48532-3450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-732-8451
Provider Business Practice Location Address Fax Number:
810-732-8980
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  JR037781 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2632697 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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