Healthcare Provider Details

I. General information

NPI: 1801250550
Provider Name (Legal Business Name): AARON BENJAMIN SIMON MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S RM 139
ORANGE CA
92868-3201
US

IV. Provider business mailing address

101 THE CITY DR S RM 139
ORANGE CA
92868-3201
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8074
  • Fax:
Mailing address:
  • Phone: 714-456-8074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberA152727
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: