Provider Demographics
NPI:1487664207
Name:BEJJANI, BASSAM K (MD)
Entity Type:Individual
Prefix:
First Name:BASSAM
Middle Name:K
Last Name:BEJJANI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:14860 ROSCOE BLVD
Mailing Address - Street 2:SUITE 308 BASSAM K BEJJANI MD
Mailing Address - City:PAMORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4698
Mailing Address - Country:US
Mailing Address - Phone:818-780-3995
Mailing Address - Fax:818-780-4061
Practice Address - Street 1:14860 ROSCOE BLVD
Practice Address - Street 2:SUITE 308 BASSAM K BEJJANI MD
Practice Address - City:PAMORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4698
Practice Address - Country:US
Practice Address - Phone:818-780-3995
Practice Address - Fax:818-780-4061
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA33388208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A333880Medicaid
A84466Medicare UPIN
CA00A333880Medicaid