Healthcare Provider Details

I. General information

NPI: 1851917348
Provider Name (Legal Business Name): ILAN YAACOV BENADOR-SHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVENUE BLDG. 5, 1ST FL.
SAN FRANCISCO CA
94110
US

IV. Provider business mailing address

1600 DIVISADERO ST RM C250
SAN FRANCISCO CA
94143-3010
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-8020
  • Fax:
Mailing address:
  • Phone: 415-885-7464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberETLL-738
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA189946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: