1073402459 NPI number — DR. DALENA MAI THI HUONG HA HA DMD, MS, MPH

Table of content: DR. DALENA MAI THI HUONG HA HA DMD, MS, MPH (NPI 1073402459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073402459 NPI number — DR. DALENA MAI THI HUONG HA HA DMD, MS, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HA
Provider First Name:
DALENA
Provider Middle Name:
MAI THI HUONG HA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD, MS, MPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073402459
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
877 S WINCHESTER BLVD UNIT 539
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95128-3100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-360-5914
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3801 MIRANDA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALO ALTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-360-5914
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/01/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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