Healthcare Provider Details

I. General information

NPI: 1801059647
Provider Name (Legal Business Name): BENJAMIN BASSERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9454 WILSHIRE BLVD STE 510
BEVERLY HILLS CA
90212-2904
US

IV. Provider business mailing address

2355 WESTWOOD BLVD # 844
LOS ANGELES CA
90064-2109
US

V. Phone/Fax

Practice location:
  • Phone: 310-855-5855
  • Fax: 310-855-5819
Mailing address:
  • Phone: 310-855-5855
  • Fax: 310-855-5819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA107388
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: