Provider Demographics
NPI:1679899710
Name:HASSID, BENJAMIN G
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:G
Last Name:HASSID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 5TH AVE
Mailing Address - Street 2:APT 102
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-3853
Mailing Address - Country:US
Mailing Address - Phone:646-320-6477
Mailing Address - Fax:
Practice Address - Street 1:513 PARNASSUS AVE
Practice Address - Street 2:S-357
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2205
Practice Address - Country:US
Practice Address - Phone:415-476-2776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264848207R00000X
390200000X
CAA125570207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program