Provider Demographics
NPI:1174279335
Name:WAT, BENJAMIN WAI-HO
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:WAI-HO
Last Name:WAT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-47 GRAMPIAN ROAD
Mailing Address - Street 2:
Mailing Address - City:KOWLOON CITY
Mailing Address - State:KOWLOON
Mailing Address - Zip Code:000000
Mailing Address - Country:HK
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45-47 GRAMPIAN ROAD
Practice Address - Street 2:
Practice Address - City:KOWLOON CITY
Practice Address - State:KOWLOON
Practice Address - Zip Code:000000
Practice Address - Country:HK
Practice Address - Phone:626-864-4311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30985106H00000X
CALMFT30985106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist