Healthcare Provider Details

I. General information

NPI: 1568037984
Provider Name (Legal Business Name): PEJMAN BEHIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PEJMAN BEHINAEIN DDS

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 FAIRMOUNT AVE 3RD FLOOR DENTAL DEPARTMENT
SAN DIEGO CA
92105-9210
US

IV. Provider business mailing address

6507 21ST AVE NE
SEATTLE WA
98115-6947
US

V. Phone/Fax

Practice location:
  • Phone: 619-564-7018
  • Fax: 619-795-9848
Mailing address:
  • Phone: 805-990-9115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number107966
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: