Healthcare Provider Details

I. General information

NPI: 1467284620
Provider Name (Legal Business Name): KATHRYN HA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE HA

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SULLIVAN AVE
DALY CITY CA
94015-2200
US

IV. Provider business mailing address

1900 SULLIVAN AVE
DALY CITY CA
94015-2200
US

V. Phone/Fax

Practice location:
  • Phone: 650-992-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95035688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: