Provider Demographics
NPI:1174866040
Name:DA, BEN LIN (MD)
Entity type:Individual
Prefix:DR
First Name:BEN
Middle Name:LIN
Last Name:DA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:45 PARK LN S APT 807
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-3107
Mailing Address - Country:US
Mailing Address - Phone:908-642-4301
Mailing Address - Fax:760-227-5203
Practice Address - Street 1:45 PARK LN S APT 807
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310-3107
Practice Address - Country:US
Practice Address - Phone:908-642-4301
Practice Address - Fax:760-227-5203
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA133137207RG0100X, 207RI0008X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatologyGroup - Single Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABD3232267556OtherBD3232267556