Provider Demographics
NPI:1699982629
Name:KYMINH T. HA
Entity type:Organization
Organization Name:KYMINH T. HA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KYMINH
Authorized Official - Middle Name:T
Authorized Official - Last Name:HA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:408-482-1356
Mailing Address - Street 1:1569 LEXANN AVE
Mailing Address - Street 2:116
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121
Mailing Address - Country:US
Mailing Address - Phone:408-482-1356
Mailing Address - Fax:
Practice Address - Street 1:1569 LEXANN AVE
Practice Address - Street 2:116
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121
Practice Address - Country:US
Practice Address - Phone:408-482-1356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA515881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty