Provider Demographics
NPI:1285379263
Name:BEDOR, KATHRYN
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BEDOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:BEDOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LE
Mailing Address - Street 1:3632 1/2 MEADE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-3619
Mailing Address - Country:US
Mailing Address - Phone:206-829-0218
Mailing Address - Fax:
Practice Address - Street 1:9750 MIRAMAR RD STE 130
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4561
Practice Address - Country:US
Practice Address - Phone:206-829-0218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL9694171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor