Provider Demographics
NPI:1962735662
Name:DERMATOLOGY AND HAIR RESTORATION SPECIALISTS,INC.
Entity type:Organization
Organization Name:DERMATOLOGY AND HAIR RESTORATION SPECIALISTS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BEHNAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-433-8143
Mailing Address - Street 1:2825 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 303A
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2429
Mailing Address - Country:US
Mailing Address - Phone:888-543-8424
Mailing Address - Fax:
Practice Address - Street 1:2825 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 303A
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2429
Practice Address - Country:US
Practice Address - Phone:888-543-8424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-13
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95319207NI0002X
CAA96639207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty