Healthcare Provider Details

I. General information

NPI: 1063667830
Provider Name (Legal Business Name): BEENA KAZI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14971 HOLT AVE
TUSTIN CA
92780-3406
US

IV. Provider business mailing address

231 E WOODSTOCK AVE
ORANGE CA
92865-2730
US

V. Phone/Fax

Practice location:
  • Phone: 949-356-7676
  • Fax:
Mailing address:
  • Phone: 408-705-5791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP10032066
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberA132259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: