Provider Demographics
NPI:1740712041
Name:BEN-DAVID, SIVAN (DO)
Entity type:Individual
Prefix:
First Name:SIVAN
Middle Name:
Last Name:BEN-DAVID
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19260 SW 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-5701
Mailing Address - Country:US
Mailing Address - Phone:503-691-9777
Mailing Address - Fax:
Practice Address - Street 1:19260 SW 65TH AVE
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-5701
Practice Address - Country:US
Practice Address - Phone:503-691-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A17201208000000X
ORDO209886208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics