Provider Demographics
NPI:1457360935
Name:LEWIS, ALAN BENEDICT (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:BENEDICT
Last Name:LEWIS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4650 W SUNSET BLVD
Mailing Address - Street 2:CHILDREN'S HOSPITAL LOS ANGELES, MS#34
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-361-4637
Mailing Address - Fax:323-361-1513
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:CHILDREN'S HOSPITAL LOS ANGELES, MS#34
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-4637
Practice Address - Fax:323-361-1513
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2011-07-25
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Provider Licenses
StateLicense IDTaxonomies
CAG233142080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G233140Medicaid
WG23314Medicare ID - Type Unspecified
CA00G233140Medicaid