Provider Demographics
NPI:1285094714
Name:HA, KHANH (DMD)
Entity type:Individual
Prefix:
First Name:KHANH
Middle Name:
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 1:1300 S CAGE BLVD STE K
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-6352
Mailing Address - Country:US
Mailing Address - Phone:956-413-7540
Mailing Address - Fax:
Practice Address - Street 1:1300 S CAGE BLVD STE K
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6352
Practice Address - Country:US
Practice Address - Phone:956-413-7540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170149381223G0001X
TX35753122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNAOtherNA