MEDICARE: DR. SEONHO HA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	40603	CA

General Provider Information

NPI Number	:	1386782076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEONHO HA D.D.S.

Provider Business Mailing Address
First Line	:	3240 WILSHIRE BLVD STE 510
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-1504
Country	:	US
Telephone Number	:	213-365-1008
Fax Number	:	213-365-0934

Provider Business Practice Location Address
First Line	:	3240 WILSHIRE BLVD STE 510
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-1504
Country	:	US
Telephone Number	:	213-365-1008
Fax Number	:	213-365-0934

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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