Provider Demographics
NPI:1043305774
Name:HA, BEN (MD,)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:
Last Name:HA
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W COLLEGE ST
Mailing Address - Street 2:SUITE 540
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-1163
Mailing Address - Country:US
Mailing Address - Phone:213-626-5151
Mailing Address - Fax:213-626-0510
Practice Address - Street 1:711 W COLLEGE ST
Practice Address - Street 2:SUITE 540
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-1163
Practice Address - Country:US
Practice Address - Phone:213-626-5151
Practice Address - Fax:213-626-0510
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70143207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A701430Medicaid
CA00A701430Medicaid
CAWA70143AMedicare ID - Type Unspecified