Healthcare Provider Details

I. General information

NPI: 1831728831
Provider Name (Legal Business Name): DR. SAFEDIN BEQAJ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12634 HOOVER ST
GARDEN GROVE CA
92841-4165
US

IV. Provider business mailing address

63 DIAMOND
IRVINE CA
92620-2143
US

V. Phone/Fax

Practice location:
  • Phone: 949-208-0521
  • Fax:
Mailing address:
  • Phone: 847-769-3701
  • Fax: 949-312-4227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number2050317
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License NumberDRG-01003091
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: