Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | MD61132712 | WA |
NPI | 1013302520 |
---|---|
Provider Name | Johnathan Ha |
First Address | Lakewood, WA 98499-3051 |
Second Address | Lakewood, WA 98499-3051 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2015 |
Last Update Date | 16/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2180700 | (05) | WA |