Healthcare Provider Details

I. General information

NPI: 1235181728
Provider Name (Legal Business Name): LYNN BENNION M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 12/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E EL CAMINO REAL
MOUNTAIN VIEW CA
94040-2833
US

IV. Provider business mailing address

701 E EL CAMINO REAL
MOUNTAIN VIEW CA
94040-2833
US

V. Phone/Fax

Practice location:
  • Phone: 408-739-6000
  • Fax:
Mailing address:
  • Phone: 408-739-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberG36683
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: