Healthcare Provider Details

I. General information

NPI: 1932191590
Provider Name (Legal Business Name): BENJAMIN Y WANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8750 WILSHIRE BLVD STE 100
BEVERLY HILLS CA
90211-2708
US

IV. Provider business mailing address

PO BOX 2030
LOWELL AR
72745-2030
US

V. Phone/Fax

Practice location:
  • Phone: 310-689-3100
  • Fax:
Mailing address:
  • Phone: 855-381-9178
  • Fax: 913-234-1116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA60595
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberK4604
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: