Provider Demographics
NPI:1487095279
Name:HA, ANNIE YI YAN (DDS)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:YI YAN
Last Name:HA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1074 JACKSON XING
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2039
Mailing Address - Country:US
Mailing Address - Phone:517-840-0000
Mailing Address - Fax:517-841-0180
Practice Address - Street 1:17401 BASTANCHURY RD STE 103
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-1320
Practice Address - Country:US
Practice Address - Phone:714-524-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist