Healthcare Provider Details

I. General information

NPI: 1821450396
Provider Name (Legal Business Name): DAVID BENJAMIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOAG DR BLDG 41
NEWPORT BEACH CA
92663-4162
US

IV. Provider business mailing address

1 HOAG DR BLDG 41
NEWPORT BEACH CA
92663-4162
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA151232
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: