Provider Demographics
NPI:1891207031
Name:RHA, KYUNG RHAN
Entity Type:Individual
Prefix:DR
First Name:KYUNG RHAN
Middle Name:
Last Name:RHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 SCOTT BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-4517
Mailing Address - Country:US
Mailing Address - Phone:408-246-0300
Mailing Address - Fax:408-246-5131
Practice Address - Street 1:2150 THE ALAMEDA
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1144
Practice Address - Country:US
Practice Address - Phone:408-246-0300
Practice Address - Fax:408-246-5131
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-27
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA471661223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics