Benjamin William Walline, DDS, MD

Primary specialty

Plastic Surgery within the Head & Neck (Otolaryngology) PhysicianTaxonomy code 207YX0007X

License

A98343 Issued in CA

Practice address

2080 Century Park E
#610
Los Angeles, CA 90067-2001

Phone

(310) 842-4811

Fax

(310) 286-2177

NPI assigned

Aug 30, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 23, 2016 through Mar 23, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350345600000",
    "number": "1073707212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2080 CENTURY PARK E",
            "address_2": "#610",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900672001",
            "telephone_number": "310-842-4811",
            "fax_number": "310-286-2177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 CENTURY PARK E",
            "address_2": "#610",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900672001",
            "telephone_number": "310-842-4811",
            "fax_number": "310-286-2177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLINE",
        "first_name": "BENJAMIN",
        "middle_name": "WILLIAM",
        "credential": "DDS, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-30",
        "last_updated": "2012-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "CA",
            "license": "A98343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donald E. Wallens, M.D.
• Jonathan M Waller, MA CCC-SLP
• Todd Steven Waller, M.D.
• Wynton Wallers
• Derek Wallin, D.D.S.
• Anne Walling, MD
• Christopher Glenn Walling, PSYD
• Wallis Annenberg High
• Roi Ann Wallis, M.D.
• Lillie Belle Walls, RADT

• Plastic Surgery within the Head & Neck (Otolaryngology) Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Plastic Surgery within the Head & Neck (Otolaryngology) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.