Provider Demographics
NPI:1396751384
Name:BEYDOUN, TALAL (MD)
Entity type:Individual
Prefix:DR
First Name:TALAL
Middle Name:
Last Name:BEYDOUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27401 LOS ALTOS
Mailing Address - Street 2:STE 150
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8013
Mailing Address - Country:US
Mailing Address - Phone:949-367-1010
Mailing Address - Fax:949-367-1011
Practice Address - Street 1:27401 LOS ALTOS
Practice Address - Street 2:SUITE 150
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-367-1010
Practice Address - Fax:949-367-1011
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA305562085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G86499Medicare UPIN