Provider Demographics
NPI:1093083701
Name:BENJAMIN N. WAN, M.D., INC
Entity Type:Organization
Organization Name:BENJAMIN N. WAN, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-665-6100
Mailing Address - Street 1:595 BUCKINGHAM WAY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1909
Mailing Address - Country:US
Mailing Address - Phone:415-665-6100
Mailing Address - Fax:415-665-6101
Practice Address - Street 1:595 BUCKINGHAM WAY
Practice Address - Street 2:SUITE 500
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1909
Practice Address - Country:US
Practice Address - Phone:415-665-6100
Practice Address - Fax:415-665-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92050208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty