Basic Information
| Provider Information | |||||||||
| NPI: | 1184811952 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOO | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | KAI PAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WOO | ||||||||
| OtherFirstName: | KAI | ||||||||
| OtherMiddleName: | PAN | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1830 FLOWER ST RM 3057 | ||||||||
| Address2: | DEPARTMENT OF PSYCHIATRY, UCLA-KERN | ||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933054144 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1830 FLOWER ST RM 3057 | ||||||||
| Address2: | DEPARTMENT OF PSYCHIATRY, UCLA-KERN | ||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933054144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613265411 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2007 | ||||||||
| LastUpdateDate: | 09/26/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | A96701 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | A96701 | 01 | CA | MEDICAL LICENSE | OTHER | BW9951268 | 01 | CA | DEA REGISTRATION NUMBER | OTHER |