Provider Demographics
NPI:1942353032
Name:WAN, BENJAMIN NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:NICHOLAS
Last Name:WAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:595 BUCKINGHAM WAY
Mailing Address - Street 2:STE 500
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1909
Mailing Address - Country:US
Mailing Address - Phone:415-665-6100
Mailing Address - Fax:415-665-6101
Practice Address - Street 1:595 BUCKINGHAM WAY
Practice Address - Street 2:STE 500
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1909
Practice Address - Country:US
Practice Address - Phone:415-665-6100
Practice Address - Fax:415-665-6101
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA92050208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics