Healthcare Provider Details

I. General information

NPI: 1174786594
Provider Name (Legal Business Name): HASSAN KARIMI BENCHEQROUN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 02/08/2020
Certification Date: 02/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E TACHEVAH DR STE 1W104
PALM SPRINGS CA
92262-5772
US

IV. Provider business mailing address

900 E PALM CANYON DR UNIT 203
PALM SPRINGS CA
92264-2524
US

V. Phone/Fax

Practice location:
  • Phone: 760-618-1353
  • Fax: 760-259-2001
Mailing address:
  • Phone: 760-459-5009
  • Fax: 760-259-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA112435
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA112435
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: