Healthcare Provider Details

I. General information

NPI: 1275809212
Provider Name (Legal Business Name): CHUNG MEA HA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2012
Last Update Date: 05/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 E 42ND AVE STE 101
ANCHORAGE AK
99508-5228
US

IV. Provider business mailing address

2401 E 42ND AVE STE 101
ANCHORAGE AK
99508-5228
US

V. Phone/Fax

Practice location:
  • Phone: 907-519-6751
  • Fax: 888-339-9501
Mailing address:
  • Phone: 907-519-6751
  • Fax: 888-339-9501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number968887
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierMPG0477
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name: CHUNG MEA HA
Title or Position: OWNER
Credential: MD
Phone: 907-519-6751