Provider Demographics
NPI:1972360303
Name:KYOUNG TAE HA, D.D.S., INC.
Entity Type:Organization
Organization Name:KYOUNG TAE HA, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYOUNG TAE
Authorized Official - Middle Name:
Authorized Official - Last Name:HA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-873-6691
Mailing Address - Street 1:1603 W CARA DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-6578
Mailing Address - Country:US
Mailing Address - Phone:714-873-6691
Mailing Address - Fax:
Practice Address - Street 1:439 S EUCLID ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-1229
Practice Address - Country:US
Practice Address - Phone:714-873-6691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty