Provider Demographics
NPI:1942753736
Name:HA, SEUNGWAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEUNGWAN
Middle Name:
Last Name:HA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SAINT FRANCIS PL APT 4608
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1336
Mailing Address - Country:US
Mailing Address - Phone:415-697-4253
Mailing Address - Fax:
Practice Address - Street 1:1 SAINT FRANCIS PL APT 4608
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1336
Practice Address - Country:US
Practice Address - Phone:415-697-4253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100568122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist