Provider Demographics
NPI:1578908422
Name:BENJAMIN BASSERI MD INC.
Entity Type:Organization
Organization Name:BENJAMIN BASSERI MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-922-2613
Mailing Address - Street 1:8631 W 3RD ST STE 1015E
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5925
Mailing Address - Country:US
Mailing Address - Phone:310-652-4472
Mailing Address - Fax:310-358-2266
Practice Address - Street 1:8631 W 3RD ST STE 1015E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5925
Practice Address - Country:US
Practice Address - Phone:310-652-4472
Practice Address - Fax:310-358-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty