Provider Demographics
NPI:1720278534
Name:BEHNAM, BEN E (MD)
Entity type:Individual
Prefix:DR
First Name:BEN
Middle Name:E
Last Name:BEHNAM
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 1:11669 SANTA MONICA BLVD
Mailing Address - Street 2:ST 110
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2991
Mailing Address - Country:US
Mailing Address - Phone:310-315-4989
Mailing Address - Fax:310-998-3282
Practice Address - Street 1:11669 SANTA MONICA BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2929
Practice Address - Country:US
Practice Address - Phone:310-315-4989
Practice Address - Fax:310-998-3282
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95319174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist