Provider Demographics
NPI:1477532018
Name:HA, RICHARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:HA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JUNE
Other - Middle Name:Y
Other - Last Name:HA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2780 EUREKA WAY
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0223
Practice Address - Country:US
Practice Address - Phone:530-229-0360
Practice Address - Fax:530-229-0856
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9308207RC0000X
CAC144964207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201280211Medicaid
MO201280211Medicaid
B18447Medicare UPIN