Basic Information
| Provider Information | |||||||||
| NPI: | 1790755312 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RHEE | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 74-517 HONOKOHAU ST | ||||||||
| Address2: | |||||||||
| City: | KAILUA KONA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967402715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083344400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 74-517 HONOKOHAU ST | ||||||||
| Address2: | |||||||||
| City: | KAILUA KONA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967402715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083344400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2006 | ||||||||
| LastUpdateDate: | 06/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD-10754 | HI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 9949 | NV | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 2078475 | 05 | NV | MEDICAID | 3102675 | 05 | NV | MEDICAID | 1790755312 | 05 | NV | MEDICAID |