Healthcare Provider Details

I. General information

NPI: 1356275077
Provider Name (Legal Business Name): BENJAMIN HUU SIN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5584 N PARAMOUNT BLVD STE 100
LONG BEACH CA
90805-5149
US

IV. Provider business mailing address

9510 PARKER LN
GARDENA CA
90248-1417
US

V. Phone/Fax

Practice location:
  • Phone: 562-920-8394
  • Fax:
Mailing address:
  • Phone: 424-603-8566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT11200
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: