Provider Demographics
NPI:1669933966
Name:GHIAM, BENJAMIN KAMBIZ (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:KAMBIZ
Last Name:GHIAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16542 VENTURA BLVD STE 515
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4581
Mailing Address - Country:US
Mailing Address - Phone:818-387-6565
Mailing Address - Fax:818-387-6288
Practice Address - Street 1:16542 VENTURA BLVD STE 515
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4581
Practice Address - Country:US
Practice Address - Phone:818-387-6565
Practice Address - Fax:818-387-6288
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA185965207WX0109X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology