Provider Demographics
NPI:1295153740
Name:BEJJANI, ANTHONY CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:CHARLES
Last Name:BEJJANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22525 N SUMMIT RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-2673
Mailing Address - Country:US
Mailing Address - Phone:818-522-5949
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL PLAZA SUITE 120
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-2673
Practice Address - Country:US
Practice Address - Phone:310-825-6301
Practice Address - Fax:310-794-1699
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA143151207RH0003X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program