Provider Demographics
NPI:1386655843
Name:ZANDPOUR, BEN (MD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:
Last Name:ZANDPOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:32357 PHANTOM DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-6112
Mailing Address - Country:US
Mailing Address - Phone:949-400-8867
Mailing Address - Fax:310-374-9196
Practice Address - Street 1:32357 PHANTOM DR
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-6112
Practice Address - Country:US
Practice Address - Phone:949-400-8867
Practice Address - Fax:310-374-9196
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA73201207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH45423Medicare UPIN