Provider Demographics
NPI:1063795201
Name:DONG, BENHAO (MD)
Entity type:Individual
Prefix:
First Name:BENHAO
Middle Name:
Last Name:DONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 XIANXIA ROAD
Mailing Address - Street 2:SHANGHAI UNITED FAMILY HOSPITAL
Mailing Address - City:SHANGHAI
Mailing Address - State:SHANGHAI
Mailing Address - Zip Code:200336
Mailing Address - Country:CN
Mailing Address - Phone:861391-657-6014
Mailing Address - Fax:
Practice Address - Street 1:1139 XIANXIA ROAD
Practice Address - Street 2:SHANGHAI UNITED FAMILY HOSPITAL
Practice Address - City:SHANGHAI
Practice Address - State:SHANGHAI
Practice Address - Zip Code:200336
Practice Address - Country:CN
Practice Address - Phone:861391-657-6014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2011-09-23
Deactivation Date:2010-11-05
Deactivation Code:
Reactivation Date:2011-09-23
Provider Licenses
StateLicense IDTaxonomies
CAA76018207R00000X
NY214270207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine