MEDICARE: DR. KRISTIN BEIZAI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	29202	TN
2	2084P0800X	Psychiatry Physician	A62658	CA

General Provider Information

NPI Number	:	1477510428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTIN BEIZAI MD

Provider Business Mailing Address
First Line	:	13335 WINSTANLEY WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-1403
Country	:	US
Telephone Number	:	858-703-4029
Fax Number	:

Provider Business Practice Location Address
First Line	:	3350 VIA LA JOLLA
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92161-0001
Country	:	US
Telephone Number	:	858-642-3686
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/08/2007

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