Basic Information
| Provider Information | |||||||||
| NPI: | 1225217953 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEN BHUPENDRA PRADHAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 20TH ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904042050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108287757 | ||||||||
| FaxNumber: | 3108286687 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 20TH ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904042050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108287757 | ||||||||
| FaxNumber: | 3108286687 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2007 | ||||||||
| LastUpdateDate: | 05/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | PRADHAN | ||||||||
| AuthorizedOfficialFirstName: | BEN | ||||||||
| AuthorizedOfficialMiddleName: | BHUPENDRA | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3108287757 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD, MS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0117X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | W17987 | 01 | CA | MEDICARE GROUP NUMBER | OTHER |