Provider Demographics
NPI:1487894473
Name:RENAISSANCE PLASTIC RECONSTRUCTIVE AESTHETIC SURGERY
Entity type:Organization
Organization Name:RENAISSANCE PLASTIC RECONSTRUCTIVE AESTHETIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:HEE-JIN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-548-9312
Mailing Address - Street 1:351 HOSPITAL RD
Mailing Address - Street 2:SUITE 218
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3509
Mailing Address - Country:US
Mailing Address - Phone:949-548-9312
Mailing Address - Fax:949-548-9623
Practice Address - Street 1:351 HOSPITAL RD
Practice Address - Street 2:SUITE 218
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3509
Practice Address - Country:US
Practice Address - Phone:949-548-9312
Practice Address - Fax:949-548-9623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81552174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty