Provider Demographics
NPI:1831728831
Name:BEQAJ, SAFEDIN
Entity type:Individual
Prefix:DR
First Name:SAFEDIN
Middle Name:
Last Name:BEQAJ
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 1:63 DIAMOND
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-2143
Mailing Address - Country:US
Mailing Address - Phone:847-769-3701
Mailing Address - Fax:949-312-4227
Practice Address - Street 1:12634 HOOVER ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-4165
Practice Address - Country:US
Practice Address - Phone:949-208-0521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2050317291U00000X
CADRG-01003091170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
No291U00000XLaboratoriesClinical Medical Laboratory