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General NPI Number Information
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NPI Number | 1063667830
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Entity Type | Individual
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Provider Name | BEENA KAZI M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/20/2008
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Last Update Date | 09/21/2021
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Provider Practice Location Address
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Address Line | 14971 HOLT AVE
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City | TUSTIN
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State | CA
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Zip | 92780-3406
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Country | US
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Telephone | 949-356-7676
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Fax |
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Provider Business Mailing Address
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Address Line | 231 E WOODSTOCK AVE
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City | ORANGE
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State | CA
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Zip | 92865-2730
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Country | US
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Telephone | 408-705-5791
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | BP10032066
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207PP0204X
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Taxonomy Name | Pediatric Emergency Medicine (Emergency Medicine) Physician
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License Number | A132259
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License Number State | CA
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