Healthcare Provider Details

I. General information

NPI: 1245996776
Provider Name (Legal Business Name): BENZEN BYRON CO LIM PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1086 S FAIRFAX AVE
LOS ANGELES CA
90019-4401
US

IV. Provider business mailing address

675 BONNIE CLAIRE DR
WALNUT CA
91789-4197
US

V. Phone/Fax

Practice location:
  • Phone: 424-258-0124
  • Fax:
Mailing address:
  • Phone: 626-800-8079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA62168
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: