Provider Demographics
NPI:1083675516
Name:HA, TERRISA SUN MI
Entity Type:Individual
Prefix:
First Name:TERRISA
Middle Name:SUN MI
Last Name:HA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5451 LA PALMA AVE
Mailing Address - Street 2:SUITE 49
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1728
Mailing Address - Country:US
Mailing Address - Phone:714-736-9918
Mailing Address - Fax:714-736-9952
Practice Address - Street 1:5451 LA PALMA AVE
Practice Address - Street 2:SUITE 49
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1728
Practice Address - Country:US
Practice Address - Phone:714-736-9918
Practice Address - Fax:714-736-9952
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-02
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG074991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F87244Medicare UPIN
G74991Medicare ID - Type Unspecified