Provider Demographics
NPI:1598853012
Name:GOZUN, BENJAMIN VICTOR III (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:VICTOR
Last Name:GOZUN
Suffix:III
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 1:94-216 FARRINGTON HWY
Mailing Address - Street 2:SUITE B2-101
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-1922
Mailing Address - Country:US
Mailing Address - Phone:808-678-0091
Mailing Address - Fax:808-677-1372
Practice Address - Street 1:94-216 FARRINGTON HWY
Practice Address - Street 2:SUITE B2-101
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1922
Practice Address - Country:US
Practice Address - Phone:808-678-0091
Practice Address - Fax:808-677-1372
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 9576207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI079914Medicaid
HI079914Medicaid
G38476Medicare UPIN