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General NPI Number Information
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NPI Number | 1093083701
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Entity Type | Organization
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Legal Business Name | BENJAMIN N. WAN, M.D., INC
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Dates
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Enumeration Date | 12/08/2011
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Last Update Date | 12/08/2011
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Provider Practice Location Address
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Address Line | 595 BUCKINGHAM WAY SUITE 500
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City | SAN FRANCISCO
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State | CA
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Zip | 94132-1909
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Country | US
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Telephone | 415-665-6100
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Fax | 415-665-6101
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Provider Business Mailing Address
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Address Line | 595 BUCKINGHAM WAY SUITE 500
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City | SAN FRANCISCO
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State | CA
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Zip | 94132-1909
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Country | US
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Telephone | 415-665-6100
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Fax | 415-665-6101
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BENJAMIN WAN
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Credential | M.D.
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Telephone | 415-665-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A92050
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License Number State | CA
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