Provider Demographics
NPI:1891877940
Name:HA, TONY (MD)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:
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:PO BOX 9787
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98909
Mailing Address - Country:US
Mailing Address - Phone:509-574-3353
Mailing Address - Fax:509-225-3168
Practice Address - Street 1:808 N 39TH AVENUE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902
Practice Address - Country:US
Practice Address - Phone:509-574-3400
Practice Address - Fax:509-574-3464
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032983207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8178535Medicaid
WA1093798Medicaid
WAG12753Medicare UPIN
WA1093798Medicaid
WA8854982Medicare PIN