Basic Information
Provider Information
NPI: 1356874218
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BESHAY
FirstName: ABRAM
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4300 ROSE DR
Address2:  
City: YORBA LINDA
State: CA
PostalCode: 928862026
CountryCode: US
TelephoneNumber: 7145284211
FaxNumber:  
Practice Location
Address1: 4300 ROSE DR
Address2:  
City: YORBA LINDA
State: CA
PostalCode: 928862026
CountryCode: US
TelephoneNumber: 7145284211
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/07/2017
LastUpdateDate: 12/03/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/03/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207N00000X10979090-1205UTN Allopathic & Osteopathic PhysiciansDermatology 
207N00000XA157977CAY Allopathic & Osteopathic PhysiciansDermatology 

No ID Information.


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