Healthcare Provider Details

I. General information

NPI: 1730318957
Provider Name (Legal Business Name): BENJAMIN FRANKLIN CHOW PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S GRAND AVE SUITE 800
LOS ANGELES CA
90015-3048
US

IV. Provider business mailing address

PO BOX 5643
DIAMOND BAR CA
91765-7643
US

V. Phone/Fax

Practice location:
  • Phone: 213-748-1414
  • Fax:
Mailing address:
  • Phone: 323-629-1537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number00023819
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20180
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: