Provider Demographics
NPI:1568447860
Name:HA, TUONG T (MD)
Entity Type:Individual
Prefix:
First Name:TUONG
Middle Name:T
Last Name:HA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:T
Other - Last Name:HA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:933 SOLEM ST
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-4253
Mailing Address - Country:US
Mailing Address - Phone:626-280-2803
Mailing Address - Fax:626-280-6124
Practice Address - Street 1:530 W BADILLO ST
Practice Address - Street 2:#E
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-3787
Practice Address - Country:US
Practice Address - Phone:626-280-2803
Practice Address - Fax:626-280-6124
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43426207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A434260Medicaid
CAC35554Medicare UPIN
CAA43426Medicare ID - Type Unspecified