Provider Demographics
NPI:1245233154
Name:HUNG, BENJAMIN J (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:J
Last Name:HUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S 70TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-7901
Mailing Address - Country:US
Mailing Address - Phone:402-441-4760
Mailing Address - Fax:402-441-4764
Practice Address - Street 1:575 S 70TH ST
Practice Address - Street 2:STE 310
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510
Practice Address - Country:US
Practice Address - Phone:402-441-4760
Practice Address - Fax:402-441-4764
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21773208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1700494OtherUHC - SURGICAL ASSOC
MO208935817Medicaid
NE229843OtherMIDLANDS - SURGICAL ASSOC
P00321412OtherRRM
IA1714220Medicaid
NE229843OtherMIDLANDS CHOICE - PROMED
NE35396OtherBCBS - SURGICAL ASSOC
KS100397350BMedicaid
020052045OtherRRM
NE1700452OtherSHARE ADV - PROMED
NE35881OtherBCBS - PROMED
NE68510A002OtherWPS/TRIWEST - SURGICAL
275387Medicare PIN
P00321412OtherRRM
IA1714220Medicaid