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NPI Code Detail

MEDICARE: BENZEN BYRON CO LIM PA-C

MEDICARE: BENZEN BYRON CO LIM PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2363A00000XPhysician AssistantPA62168CA

General Provider Information

NPI Number : 1245996776
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENZEN BYRON CO LIM PA-C
Provider Business Mailing Address
First Line : 675 BONNIE CLAIRE DR
Second Line :
City : WALNUT
State : CA
Zip : 91789-4197
Country : US
Telephone Number : 626-800-8079
Fax Number :
Provider Business Practice Location Address
First Line : 1086 S FAIRFAX AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90019-4401
Country : US
Telephone Number : 424-258-0124
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2021
Last Update Date : 01/09/2023

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