Basic Information
| Provider Information | |||||||||
| NPI: | 1083091649 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENSON | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | AMIR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6431 FANNIN ST. STE 5.170 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770301501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135007160 | ||||||||
| FaxNumber: | 7135000648 | ||||||||
| Practice Location | |||||||||
| Address1: | 6431 FANNIN ST. STE 5.170 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770301501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135007160 | ||||||||
| FaxNumber: | 7135000648 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2015 | ||||||||
| LastUpdateDate: | 10/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171000000X | N | Other Service Providers | Military Health Care Provider | 207L00000X | 303327 | LA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 208D00000X | 303327 | LA | N | Allopathic & Osteopathic Physicians | General Practice | 207L00000X | 727019 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.