Provider Demographics
NPI:1184905861
Name:HA, HYUN MYUNG (DDS)
Entity type:Individual
Prefix:
First Name:HYUN MYUNG
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 1:2180 LAKE TAHOE BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6409
Mailing Address - Country:US
Mailing Address - Phone:530-541-8229
Mailing Address - Fax:
Practice Address - Street 1:2180 LAKE TAHOE BLVD STE 5
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-6409
Practice Address - Country:US
Practice Address - Phone:530-541-8229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA606881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice