Provider Demographics
NPI:1609563147
Name:HA, AMBROSE MINH
Entity Type:Individual
Prefix:
First Name:AMBROSE
Middle Name:MINH
Last Name:HA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3244 SAN HELENA DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-3261
Mailing Address - Country:US
Mailing Address - Phone:760-576-7493
Mailing Address - Fax:
Practice Address - Street 1:3244 SAN HELENA DR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3261
Practice Address - Country:US
Practice Address - Phone:760-576-7493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7846122300000X
CA39020000X122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist