Provider Demographics
NPI:1003120429
Name:KERSHBERG, BENJAMIN MAURICE (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:MAURICE
Last Name:KERSHBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2150 S STATE COLLEGE BLVD
Mailing Address - Street 2:APT. 1076
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-0102
Mailing Address - Country:US
Mailing Address - Phone:310-927-4442
Mailing Address - Fax:
Practice Address - Street 1:2295 S VINEYARD AVE
Practice Address - Street 2:MOB A
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-7925
Practice Address - Country:US
Practice Address - Phone:909-724-2554
Practice Address - Fax:909-724-2552
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA111594208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics