Provider Demographics
NPI:1790814184
Name:HA, JAMES MYUNGCHIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MYUNGCHIN
Last Name:HA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4110 BOWNE ST
Mailing Address - Street 2:#L-3
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5617
Mailing Address - Country:US
Mailing Address - Phone:718-353-5730
Mailing Address - Fax:718-353-5084
Practice Address - Street 1:4110 BOWNE ST
Practice Address - Street 2:#L-3
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5617
Practice Address - Country:US
Practice Address - Phone:718-353-5730
Practice Address - Fax:718-353-5084
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY172569207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY72F82OtherEMPIRE BC & BS
NYE50304Medicare UPIN
67428Medicare ID - Type Unspecified