1619933132 NPI number — MICHAEL S BENJAMIN M.D.

Table of content: MICHAEL S BENJAMIN M.D. (NPI 1619933132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619933132 NPI number — MICHAEL S BENJAMIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENJAMIN
Provider First Name:
MICHAEL
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1619933132
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7325 MEDICAL CENTER DR STE 301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91307-1928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-570-2134
Provider Business Mailing Address Fax Number:
818-835-0485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7325 MEDICAL CENTER DR STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91307-1928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-570-2134
Provider Business Practice Location Address Fax Number:
818-835-0485
Provider Enumeration Date:
04/24/2006

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: 207RH0003X , with the licence number:  A86460 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00A864600 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ31206Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ27529Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ47615Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0044501 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W11063 . This is a "MEDICARE ID GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: W11063A . This is a "MEDICARE ID GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: GR0044500 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ70294Z , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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