Provider Demographics
NPI:1043575723
Name:KASKA, BENJAMIN CHARLES (PA-C)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:CHARLES
Last Name:KASKA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3800 KILROY AIRPORT WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-6818
Mailing Address - Country:US
Mailing Address - Phone:213-669-6453
Mailing Address - Fax:877-883-6503
Practice Address - Street 1:3800 KILROY AIRPORT WAY STE 100
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-6818
Practice Address - Country:US
Practice Address - Phone:213-669-6453
Practice Address - Fax:877-883-6503
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22317363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical