Healthcare Provider Details

I. General information

NPI: 1932639408
Provider Name (Legal Business Name): BENJAMIN THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 POST ST STE 270
SAN FRANCISCO CA
94115-3466
US

IV. Provider business mailing address

1601 KAPIOLANI BLVD STE 950
HONOLULU HI
96814-4700
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2101
  • Fax:
Mailing address:
  • Phone: 808-955-4327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD-189
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: