Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A111594 | CA |
NPI | 1003120429 |
---|---|
Provider Name | Dr. Benjamin Maurice Kershberg |
First Address | Anaheim, CA 92806-0102 |
Second Address | Ontario, CA 91761-7925 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2010 |
Last Update Date | 30/11/2021 |