Provider Demographics
NPI:1669663803
Name:HA, CHI D (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:CHI
Middle Name:D
Last Name:HA
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15725 POMERADO RD STE 212
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064
Mailing Address - Country:US
Mailing Address - Phone:858-487-3742
Mailing Address - Fax:
Practice Address - Street 1:15725 POMERADO RD STE 212
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064
Practice Address - Country:US
Practice Address - Phone:858-487-3742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1057472086X0206X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology