Provider Demographics
NPI:1538529185
Name:NEGIN BEHAZIN MD, A MED CORP
Entity type:Organization
Organization Name:NEGIN BEHAZIN MD, A MED CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEGIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHAZIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-234-2964
Mailing Address - Street 1:360 FREEMAN AVE
Mailing Address - Street 2:APT 14
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-2406
Mailing Address - Country:US
Mailing Address - Phone:409-234-2946
Mailing Address - Fax:
Practice Address - Street 1:12665 GARDEN GROVE BLVD
Practice Address - Street 2:SUITE 710
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1901
Practice Address - Country:US
Practice Address - Phone:617-281-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2016-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA131359208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty