Basic Information
| Provider Information | |||||||||
| NPI: | 1922460617 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HA | ||||||||
| FirstName: | DENNIS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13855 E 14TH ST | ||||||||
| Address2: | |||||||||
| City: | SAN LEANDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945782600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105676500 | ||||||||
| FaxNumber: | 5106674572 | ||||||||
| Practice Location | |||||||||
| Address1: | 13855 E 14TH ST | ||||||||
| Address2: | |||||||||
| City: | SAN LEANDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945782611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305676500 | ||||||||
| FaxNumber: | 5106674572 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2016 | ||||||||
| LastUpdateDate: | 09/30/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A151317 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.