Provider Demographics
NPI:1790788453
Name:LESIN, BENJAMIN E (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:E
Last Name:LESIN
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 1:14624 SHERMAN WAY
Mailing Address - Street 2:STE 303
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2288
Mailing Address - Country:US
Mailing Address - Phone:818-902-2800
Mailing Address - Fax:818-782-8979
Practice Address - Street 1:14624 SHERMAN WAY
Practice Address - Street 2:STE 303
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2288
Practice Address - Country:US
Practice Address - Phone:818-902-2800
Practice Address - Fax:818-782-8979
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG18651207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40384Medicare UPIN
CAW3130Medicare ID - Type UnspecifiedPROVIDER ID