=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902941065
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHARD HA MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2007
-----------------------------------------------------
Last Update Date | 05/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11970 N CENTRAL EXPY STE 270
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75243-3770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-818-0935
-----------------------------------------------------
Fax | 214-887-3525
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11970 N CENTRAL EXPY STE 270
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75243-3770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-818-0935
-----------------------------------------------------
Fax | 214-887-3525
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RICHARD HA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 214-818-0935
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0122X
-----------------------------------------------------
Taxonomy Name | Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number | K9795
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------