Healthcare Provider Details

I. General information

NPI: 1932795986
Provider Name (Legal Business Name): KHALED MAHMOUD SAFWAT BEDAIR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KHALED MAHMOUD SAFWAT MAHMOUD BEDAIR

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 SATURN BLVD
SAN DIEGO CA
92154-4731
US

IV. Provider business mailing address

575 SATURN BLVD
SAN DIEGO CA
92154-4731
US

V. Phone/Fax

Practice location:
  • Phone: 619-205-6147
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number83585
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: