Basic Information
| Provider Information | |||||||||
| NPI: | 1174084834 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HA | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | THIEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1411 E 31ST ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946021018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104375039 | ||||||||
| FaxNumber: | 5105357313 | ||||||||
| Practice Location | |||||||||
| Address1: | 1411 E 31ST ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946021018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104375039 | ||||||||
| FaxNumber: | 5105357313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2019 | ||||||||
| LastUpdateDate: | 08/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 20A19570 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.