Provider Demographics
NPI:1962434241
Name:BESHAY, ISAAC N (MD)
Entity type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:N
Last Name:BESHAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 HARBOR BLVD STE B210
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-5890
Mailing Address - Country:US
Mailing Address - Phone:949-548-2273
Mailing Address - Fax:949-548-4504
Practice Address - Street 1:2200 HARBOR BLVD STE B210
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-5890
Practice Address - Country:US
Practice Address - Phone:949-548-2273
Practice Address - Fax:949-548-4504
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89039207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A890390Medicaid
CA00A890390Medicare PIN
CA00A890390Medicaid
CAP00224234Medicare PIN