Provider Demographics
NPI:1184990905
Name:HA, JOON (DDS)
Entity type:Individual
Prefix:DR
First Name:JOON
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:PO BOX 20638
Mailing Address - Street 2:
Mailing Address - City:BARRIGADA
Mailing Address - State:GU
Mailing Address - Zip Code:96921-0638
Mailing Address - Country:US
Mailing Address - Phone:671-787-3338
Mailing Address - Fax:
Practice Address - Street 1:1 3 ROUTE 10 #353
Practice Address - Street 2:LOT NO. 2320-NEW-2
Practice Address - City:MANGILAO
Practice Address - State:GU
Practice Address - Zip Code:96923
Practice Address - Country:US
Practice Address - Phone:671-787-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA599411223G0001X
GUD10181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice