Provider Demographics
NPI:1598316820
Name:KORTHAS, BEN
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:KORTHAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BENJAMIN
Other - Middle Name:J
Other - Last Name:KORTHAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RT(R)
Mailing Address - Street 1:6350 COACHLIGHT DR UNIT 2201
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-2875
Mailing Address - Country:US
Mailing Address - Phone:712-540-0653
Mailing Address - Fax:
Practice Address - Street 1:3288 MOANALUA RD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1469
Practice Address - Country:US
Practice Address - Phone:808-432-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3838482085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology