Provider Demographics
NPI:1609159540
Name:HA, DONG BUM (RPH)
Entity Type:Individual
Prefix:
First Name:DONG BUM
Middle Name:
Last Name:HA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:HA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:1122 PALMVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-9149
Mailing Address - Country:US
Mailing Address - Phone:760-337-3960
Mailing Address - Fax:760-482-9262
Practice Address - Street 1:1122 PALMVIEW AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-9149
Practice Address - Country:US
Practice Address - Phone:760-337-3960
Practice Address - Fax:760-482-9262
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62279183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist