Provider Demographics
NPI:1770276917
Name:HUSSEN, BEDASA
Entity type:Individual
Prefix:
First Name:BEDASA
Middle Name:
Last Name:HUSSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 N 32ND ST APT 213
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-2956
Mailing Address - Country:US
Mailing Address - Phone:480-453-2368
Mailing Address - Fax:
Practice Address - Street 1:2020 N 32ND ST APT 213
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-2956
Practice Address - Country:US
Practice Address - Phone:480-453-2368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23526949347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle