Provider Demographics
NPI:1356581862
Name:HAM, MAGGIE YOUNGHA (MD)
Entity type:Individual
Prefix:DR
First Name:MAGGIE
Middle Name:YOUNGHA
Last Name:HAM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5767 W CENTURY BLVD
Mailing Address - Street 2:400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-301-8707
Mailing Address - Fax:310-301-8751
Practice Address - Street 1:200 MEDICAL PLZ
Practice Address - Street 2:365
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-301-8707
Practice Address - Fax:310-301-8751
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2023-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA247563207RG0100X
CAA106367207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA714131OtherTUFTS
MA9772685Medicaid
MA9772685Medicaid