Provider Demographics
NPI:1508912387
Name:BEN-YEHUDA, ORI (MD)
Entity Type:Individual
Prefix:DR
First Name:ORI
Middle Name:
Last Name:BEN-YEHUDA
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 1:4168 FRONT ST.
Mailing Address - Street 2:MAIL CODE - 8411
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-8411
Mailing Address - Country:US
Mailing Address - Phone:619-543-5743
Mailing Address - Fax:619-543-5576
Practice Address - Street 1:4168 FRONT ST
Practice Address - Street 2:MAIL CODE - 8411
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-8411
Practice Address - Country:US
Practice Address - Phone:619-543-5743
Practice Address - Fax:619-543-5576
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51936207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
F90569Medicare UPIN