Provider Demographics
NPI:1457644296
Name:BENYAMINI, POUYA (MD)
Entity Type:Individual
Prefix:
First Name:POUYA
Middle Name:
Last Name:BENYAMINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 16162
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-2162
Mailing Address - Country:US
Mailing Address - Phone:310-526-0290
Mailing Address - Fax:310-526-0290
Practice Address - Street 1:5901 W OLYMPIC BLVD STE 504
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4633
Practice Address - Country:US
Practice Address - Phone:310-526-0290
Practice Address - Fax:310-526-0290
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA122804208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery