Provider Demographics
NPI:1225304843
Name:URI BEN-ZUR M.D.,INC
Entity Type:Organization
Organization Name:URI BEN-ZUR M.D.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:URI
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEN-ZUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-986-7460
Mailing Address - Street 1:17609 VENTURA BOULEVARD
Mailing Address - Street 2:106
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316
Mailing Address - Country:US
Mailing Address - Phone:818-986-0911
Mailing Address - Fax:818-986-9301
Practice Address - Street 1:4549 HASKELL AVE
Practice Address - Street 2:4
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-3100
Practice Address - Country:US
Practice Address - Phone:818-986-7460
Practice Address - Fax:818-285-4224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75051302F00000X, 305R00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF32892Medicare UPIN
CA00G750510Medicare PIN