MEDICARE: MR. KAYVAN BINAEI PA

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	363AM0700X	Medical Physician Assistant	PA 16285	CA

General Provider Information

NPI Number	:	1861428104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KAYVAN BINAEI PA

Provider Business Mailing Address
First Line	:	7244 SHORELINE DR UNIT 144
Second Line	:	UNIT 144
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-4932
Country	:	US
Telephone Number	:	619-543-0144
Fax Number	:	619-543-0445

Provider Business Practice Location Address
First Line	:	3549 CAMINO DEL RIO S
Second Line	:	SUITE A
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4023
Country	:	US
Telephone Number	:	619-543-0144
Fax Number	:	619-543-0445

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

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	03/03/2014

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