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Individual
KENNETH HA
Active
Individual
KENNETH HA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036116719
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0222075
BLUE CROSS GROUP NUMBER
IL
05
—
036116719
—
IL
01
—
1033149844
ORGANIZATION NPI
—
01
—
363149833
TAX ID
IL
01
—
3631498336019001
CDPG HFS PAYEE ID
IL
Enumeration date
04/30/2007
Last updated
04/04/2013
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