Shane Michael Besedick, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2000001640 Issued in CA

Practice address

325 Westwood PLZ
Los Angeles, CA 90095-8356

Phone

(310) 825-3335

NPI assigned

Mar 26, 2020

Last updated

May 28, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622160000000",
    "number": "1497382576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 WESTWOOD PLZ",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900958356",
            "telephone_number": "310-825-3335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 WESTWOOD PLZ",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900958356",
            "telephone_number": "310-825-3335"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3006 Colorado Ave Apt 102",
            "address_purpose": "LOCATION",
            "city": "Santa Monica",
            "state": "CA",
            "postal_code": "904043648",
            "country_code": "US",
            "telephone_number": "818-823-7453",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BESEDICK",
        "first_name": "SHANE",
        "middle_name": "MICHAEL",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-26",
        "last_updated": "2021-05-28",
        "certification_date": "2021-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "CA",
            "license": "2000001640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony Severo Berzoza
• Stefan Besada, MD
• Katie Besanko
• Kathleen Stephanie Jayectin Besas, NP
• Elena Besbris
• Christine Acornley Besel, MSN, CNM, WHNP
• Seymour Besem, O.D.
• Farid Besharat, M.D.
• Adel Beshay, RPH
• Josuph Beshir

• Athletic Trainer in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Athletic Trainer in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.