Healthcare Provider Details

I. General information

NPI: 1821042987
Provider Name (Legal Business Name): BEN BHUPENDRA PRADHAN M.D., M.S.E.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 E WASHINGTON BLVD
PASADENA CA
91107-1412
US

IV. Provider business mailing address

2627 E WASHINGTON BLVD
PASADENA CA
91107-1412
US

V. Phone/Fax

Practice location:
  • Phone: 626-797-2002
  • Fax: 626-798-0567
Mailing address:
  • Phone: 626-797-2002
  • Fax: 626-798-0567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA70279
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: