Healthcare Provider Details

I. General information

NPI: 1669663803
Provider Name (Legal Business Name): CHI D. HA M.D., FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15725 POMERADO RD STE 212
POWAY CA
92064
US

IV. Provider business mailing address

15725 POMERADO RD STE 212
POWAY CA
92064
US

V. Phone/Fax

Practice location:
  • Phone: 858-487-3742
  • Fax:
Mailing address:
  • Phone: 858-487-3742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberA105747
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA105747
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: