Basic Information
Provider Information
NPI: 1306200563
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BEDRAN
FirstName: ASAD
MiddleName: JULIAN
NamePrefix:  
NameSuffix:  
Credential: D.O
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 130 SUTTER ST FL 2
Address2:  
City: SAN FRANCISCO
State: CA
PostalCode: 941044009
CountryCode: US
TelephoneNumber: 4156586791
FaxNumber:  
Practice Location
Address1: 8570 W SUNSET BLVD STE 1.5
Address2:  
City: WEST HOLLYWOOD
State: CA
PostalCode: 900692359
CountryCode: US
TelephoneNumber: 3105002041
FaxNumber: 3233057149
Other Information
ProviderEnumerationDate: 04/13/2016
LastUpdateDate: 07/01/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/01/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X20A15895CAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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