Provider Demographics
NPI:1750302188
Name:HA, ROBERT TAE (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:TAE
Last Name:HA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9896 GARDEN GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1643
Mailing Address - Country:US
Mailing Address - Phone:714-636-3032
Mailing Address - Fax:714-636-3116
Practice Address - Street 1:9896 GARDEN GROVE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1643
Practice Address - Country:US
Practice Address - Phone:714-636-3032
Practice Address - Fax:714-636-3116
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55299207R00000X
CAA055299207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGA753AOtherMEDICARE
CAG60135Medicare UPIN
CACX996YMedicare PIN