Provider Demographics
NPI:1063585198
Name:CHAN, BENJAMIN Z (MSW)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:Z
Last Name:CHAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:MR
Other - First Name:ZHIPING
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2620 S CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-5026
Mailing Address - Country:US
Mailing Address - Phone:626-471-6418
Mailing Address - Fax:
Practice Address - Street 1:2620 S CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-5026
Practice Address - Country:US
Practice Address - Phone:626-471-6418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 271241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical