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General NPI Number Information
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NPI Number | 1962735662
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY AND HAIR RESTORATION SPECIALISTS,INC.
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Dates
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Enumeration Date | 09/13/2009
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Last Update Date | 09/23/2013
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Provider Practice Location Address
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Address Line | 2825 SANTA MONICA BLVD SUITE 303A
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City | SANTA MONICA
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State | CA
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Zip | 90404-2429
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Country | US
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Telephone | 888-543-8424
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Fax |
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Provider Business Mailing Address
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Address Line | 2825 SANTA MONICA BLVD SUITE 303A
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City | SANTA MONICA
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State | CA
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Zip | 90404-2429
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Country | US
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Telephone | 888-543-8424
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Fax |
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Authorized Official
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Title or Position | DERMATOLOGIST
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Name | DR. BEN E BEHNAM
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Credential | MD
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Telephone | 310-433-8143
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A96639
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207NI0002X
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Taxonomy Name | Clinical & Laboratory Dermatological Immunology Physician
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License Number | A95319
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License Number State | CA
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