Provider Demographics
NPI:1710139241
Name:DYSHUN BESHEARS
Entity Type:Organization
Organization Name:DYSHUN BESHEARS
Other - Org Name:DYSHUN BESHEARS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MENTAL HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:DYSHUN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BESHEARS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:408-568-5683
Mailing Address - Street 1:1950 ALAMEDA DE LAS PULGAS
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1222
Mailing Address - Country:US
Mailing Address - Phone:650-573-2440
Mailing Address - Fax:
Practice Address - Street 1:1950 ALAMEDA DE LAS PULGAS
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1222
Practice Address - Country:US
Practice Address - Phone:650-573-2440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service