Provider Demographics
NPI:1043615628
Name:DR. BEN LITTLEJOHN INC.
Entity Type:Organization
Organization Name:DR. BEN LITTLEJOHN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:LITTLEJOHN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:510-529-3802
Mailing Address - Street 1:5915 HOLLIS ST STE B
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2066
Mailing Address - Country:US
Mailing Address - Phone:510-529-3800
Mailing Address - Fax:510-529-3803
Practice Address - Street 1:5915 HOLLIS ST STE B
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-2066
Practice Address - Country:US
Practice Address - Phone:510-529-3800
Practice Address - Fax:510-529-3803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-25
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty