Healthcare Provider Details

I. General information

NPI: 1861540072
Provider Name (Legal Business Name): KATHERINE BEDEIAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

782 47TH ST
OAKLAND CA
94609-1807
US

IV. Provider business mailing address

782 47TH ST
OAKLAND CA
94609-1807
US

V. Phone/Fax

Practice location:
  • Phone: 510-658-9409
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN418611
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: