Provider Demographics
NPI:1053382614
Name:IP, BENJAMIN HIN-MENG (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:HIN-MENG
Last Name:IP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12442 SW SCHOLLS FERRY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-0803
Mailing Address - Country:US
Mailing Address - Phone:503-215-9900
Mailing Address - Fax:503-216-9266
Practice Address - Street 1:12442 SW SCHOLLS FERRY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-3396
Practice Address - Country:US
Practice Address - Phone:503-215-9900
Practice Address - Fax:503-216-9266
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV11111207Q00000X
ORMD27464207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100503848Medicaid
OR006082Medicaid
ORR152000Medicare PIN
ORR155392Medicare PIN
ORR138481Medicare PIN
NV100503848Medicaid
NV40460Medicare PIN
ORR141919Medicare PIN
H68070Medicare UPIN
ORR144564Medicare PIN