Provider Demographics
NPI:1265175574
Name:BUNYAN, ALDEN (PA-C)
Entity type:Individual
Prefix:
First Name:ALDEN
Middle Name:
Last Name:BUNYAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8750 WILSHIRE BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2700
Mailing Address - Country:US
Mailing Address - Phone:310-652-0010
Mailing Address - Fax:
Practice Address - Street 1:8750 WILSHIRE BLVD STE 350
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2700
Practice Address - Country:US
Practice Address - Phone:310-652-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1176665363A00000X
CA60940363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant