Basic Information
| Provider Information | |||||||||
| NPI: | 1528406881 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENHAM | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1855 4TH ST | ||||||||
| Address2: | FL 3 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941432350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027413000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1725 MONTGOMERY ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941111019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156661250 | ||||||||
| FaxNumber: | 4153982696 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2013 | ||||||||
| LastUpdateDate: | 07/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | MT204983 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207V00000X | MT204983 | PA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | A148739 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.