Healthcare Provider Details

I. General information

NPI: 1831559558
Provider Name (Legal Business Name): BENEDICT KEMPER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 CARNEGIE AVE STE 1C
SANTA ANA CA
92705-5504
US

IV. Provider business mailing address

1901 CARNEGIE AVE STE 1C
SANTA ANA CA
92705-5504
US

V. Phone/Fax

Practice location:
  • Phone: 714-848-8319
  • Fax: 714-596-6274
Mailing address:
  • Phone: 714-848-8319
  • Fax: 714-596-6274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: