Provider Demographics
NPI:1730109067
Name:HU, BENJAMIN VAN (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:VAN
Last Name:HU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 BRECKSVILLE RD
Mailing Address - Street 2:UNIT 2
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-1911
Mailing Address - Country:US
Mailing Address - Phone:440-886-0005
Mailing Address - Fax:440-717-1115
Practice Address - Street 1:8801 BRECKSVILLE RD
Practice Address - Street 2:UNIT 2
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-1911
Practice Address - Country:US
Practice Address - Phone:440-886-0005
Practice Address - Fax:440-717-1115
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35056287207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0708014Medicaid
0608292Medicare ID - Type Unspecified
A17188Medicare UPIN