Healthcare Provider Details

I. General information

NPI: 1093258956
Provider Name (Legal Business Name): BENNIE-JOHN MILAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 KILROY AIRPORT WAY STE 100
LONG BEACH CA
90806-6818
US

IV. Provider business mailing address

8352 HAZELTINE AVE
PANORAMA CITY CA
91402-3758
US

V. Phone/Fax

Practice location:
  • Phone: 213-669-6453
  • Fax:
Mailing address:
  • Phone: 818-974-1915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number54020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: