Provider Demographics
NPI:1922185735
Name:HONBO, KEN SHOJI (MD FACE)
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:SHOJI
Last Name:HONBO
Suffix:
Gender:M
Credentials:MD FACE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16311 VENTURA BLVD
Mailing Address - Street 2:880
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436
Mailing Address - Country:US
Mailing Address - Phone:818-783-2000
Mailing Address - Fax:818-783-5583
Practice Address - Street 1:16311 VENTURA BLVD
Practice Address - Street 2:880
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436
Practice Address - Country:US
Practice Address - Phone:818-783-2000
Practice Address - Fax:818-783-5583
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31053207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G31053Medicare ID - Type Unspecified
A91324Medicare UPIN