Provider Demographics
NPI:1669274122
Name:JAE H HA DDS PLLC
Entity type:Organization
Organization Name:JAE H HA DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAE
Authorized Official - Middle Name:HEUNG
Authorized Official - Last Name:HA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-830-0762
Mailing Address - Street 1:4530 82ND AVENUE CT W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-2300
Mailing Address - Country:US
Mailing Address - Phone:415-830-0762
Mailing Address - Fax:
Practice Address - Street 1:4530 82ND AVENUE CT W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-2300
Practice Address - Country:US
Practice Address - Phone:415-830-0762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental