Provider Demographics
NPI:1508172404
Name:BASSAM K. BEJJANI.,M.D. INC
Entity Type:Organization
Organization Name:BASSAM K. BEJJANI.,M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BASSAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:BEJJANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-780-3995
Mailing Address - Street 1:14860 ROSCOE BLVD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4665
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
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4665
Practice Address - Country:US
Practice Address - Phone:818-780-3995
Practice Address - Fax:818-780-4061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty