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General NPI Number Information
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NPI Number | 1043615628
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Entity Type | Organization
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Legal Business Name | DR. BEN LITTLEJOHN INC.
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Dates
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Enumeration Date | 10/25/2014
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Last Update Date | 05/21/2015
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Provider Practice Location Address
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Address Line | 5915 HOLLIS ST STE B
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City | EMERYVILLE
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State | CA
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Zip | 94608-2066
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Country | US
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Telephone | 510-529-3800
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Fax | 510-529-3803
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Provider Business Mailing Address
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Address Line | 5915 HOLLIS ST STE B
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City | EMERYVILLE
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State | CA
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Zip | 94608-2066
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Country | US
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Telephone | 510-529-3800
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Fax | 510-529-3803
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Authorized Official
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Title or Position | CEO
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Name | DR. BEN LAWRENCE LITTLEJOHN III
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Credential | M.D.
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Telephone | 510-529-3802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A87510
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License Number State | CA
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