Provider Demographics
NPI:1285117184
Name:SHAM, BENJAMIN (PA-C)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:SHAM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 S GARFIELD AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-5861
Mailing Address - Country:US
Mailing Address - Phone:626-282-1600
Mailing Address - Fax:626-656-1264
Practice Address - Street 1:707 S GARFIELD AVE STE 201
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-5861
Practice Address - Country:US
Practice Address - Phone:626-282-1600
Practice Address - Fax:626-656-1264
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA55915363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical