Healthcare Provider Details

I. General information

NPI: 1891059796
Provider Name (Legal Business Name): KWANG HA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3609 10TH AVE
LOS ANGELES CA
90018-4114
US

IV. Provider business mailing address

11846 VENTURA BLVD STE 204
STUDIO CITY CA
91604-2620
US

V. Phone/Fax

Practice location:
  • Phone: 323-298-3680
  • Fax:
Mailing address:
  • Phone: 213-437-6447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number024368
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberBCPC 0593
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number33013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: