Provider Demographics
NPI:1700504248
Name:HA, TUYET N (DMD)
Entity Type:Individual
Prefix:DR
First Name:TUYET
Middle Name:N
Last Name:HA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 N LAKE AVE # 277
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1829
Mailing Address - Country:US
Mailing Address - Phone:626-688-0600
Mailing Address - Fax:
Practice Address - Street 1:1414 W COLORADO BLVD APT D
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-1414
Practice Address - Country:US
Practice Address - Phone:626-688-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107556122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist