Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | A42997 | CA |
NPI | 1205896206 |
---|---|
Provider Name | Tam Thi Ha |
First Address | Pomona, CA 91767-5628 |
Second Address | Pomona, CA 91767-5628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 30/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A429970 | (05) | CA |
E01668 | (02) |