Active NPI
Jacky B Ha
- Student in an Organized Health Care Education/Training Program
- Elk Grove, CA
National Provider Identifier
1104761865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- 390200000X
- Practice address
- 4604 Tegan Rd
Elk Grove, CA 95758-5147 - Phone
- (916) 879-1286
- NPI assigned
- Apr 21, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 390200000X | CA | Primary |
Addresses
Primary practice location
4604 Tegan Rd
Elk Grove, CA 95758-5147
Mailing address
4604 Tegan Rd
Elk Grove, CA 95758-5147
Phone (916) 879-1286
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 390200000X | CA | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1776729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1776729600000",
"number": "1104761865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4604 TEGAN RD",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "957585147",
"telephone_number": "916-879-1286"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4604 TEGAN RD",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "957585147",
"telephone_number": "916-879-1286"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HA",
"first_name": "JACKY",
"middle_name": "B",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-04-21",
"last_updated": "2026-04-21",
"certification_date": "2026-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "CA",
"license": "390200000X",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elk Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.