Basic Information
Provider Information
NPI: 1003000639
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BENHARASH
FirstName: PEYMAN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5767 W CENTURY BLVD
Address2: SUITE 400
City: LOS ANGELES
State: CA
PostalCode: 900455631
CountryCode: US
TelephoneNumber: 3108259820
FaxNumber:  
Practice Location
Address1: UCLA CARDIOTHORACIC SURGERY 10833 LECONTE AVE
Address2: 62-182 CHS
City: LOS ANGELES
State: CA
PostalCode: 900950001
CountryCode: US
TelephoneNumber: 3108259820
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/27/2007
LastUpdateDate: 02/22/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000XA85379CAY Allopathic & Osteopathic PhysiciansSurgery 

ID Information
IDTypeStateIssuerDescription
00A85379005CA MEDICAID


Home