Provider Demographics
NPI:1053778712
Name:HA, TAI (DDS)
Entity type:Individual
Prefix:
First Name:TAI
Middle Name:
Last Name:HA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 AVOCADO AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7705
Mailing Address - Country:US
Mailing Address - Phone:949-706-7097
Mailing Address - Fax:
Practice Address - Street 1:1441 AVOCADO AVE STE 404
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7705
Practice Address - Country:US
Practice Address - Phone:949-706-7097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65341122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist