Healthcare Provider Details

I. General information

NPI: 1447439559
Provider Name (Legal Business Name): BENY BEHNAM CHARCHIAN M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9730 WILSHIRE BLVD SUITE #110
BEVERLY HILLS CA
90212-2022
US

IV. Provider business mailing address

9730 WILSHIRE BLVD SUITE #110
BEVERLY HILLS CA
90212-2022
US

V. Phone/Fax

Practice location:
  • Phone: 310-274-1500
  • Fax:
Mailing address:
  • Phone: 310-274-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA103349
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA103349
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: