Individual provider Active NPI

Khanh Ngoc Bao Hua

  • Marriage & Family Therapist
  • La Habra, CA
National Provider Identifier
1346499019
Registry record updated Oct 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
52191 Issued in CA
Practice address
601 E Imperial Hwy
La Habra, CA 90631-7463
Phone
(714) 644-6480
NPI assigned
Sep 17, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X MFC52191 CA
Marriage & Family Therapist 106H00000X 52191 CA Primary

Addresses

Primary practice location

601 E Imperial Hwy
La Habra, CA 90631-7463

Mailing address

601 E Imperial Hwy
La Habra, CA 90631-7463
Phone (714) 644-6480

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250131001602 CA Practitioner - Marriage and Family Therapist 6507395803 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MFC52191CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Nov 4, 2024 Accepting new patients
Southern California Permanente Medical Group CurrentSince Nov 4, 2024 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients

Locations

5475 E La Palma Ave
Anaheim, CA 92807
Phone (714) 279-6088

601 E Imperial Hwy
La Habra, CA 90631
Phone (714) 644-6480

393 E Walnut St
Fl 5
Pasadena, CA 91188
Phone (310) 403-3235

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1221609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1346499019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 E IMPERIAL HWY",
            "city": "LA HABRA",
            "state": "CA",
            "postal_code": "906317463",
            "telephone_number": "714-644-6480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 E IMPERIAL HWY",
            "city": "LA HABRA",
            "state": "CA",
            "postal_code": "906317463",
            "telephone_number": "714-644-6480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUA",
        "first_name": "KHANH",
        "middle_name": "NGOC BAO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-17",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC52191",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "52191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Habra, CA

Sources for this page

Verify at the official NPI Registry.