Healthcare Provider Details

I. General information

NPI: 1316800931
Provider Name (Legal Business Name): BENJAMIN KAISER MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 RIO LINDO AVE
CHICO CA
95926-1817
US

IV. Provider business mailing address

101 RISA WAY APT 72
CHICO CA
95973-5008
US

V. Phone/Fax

Practice location:
  • Phone: 530-345-3491
  • Fax:
Mailing address:
  • Phone: 916-622-3994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-TQOKMY
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: