Individual provider Active NPI

Pejman Behin, DDS

  • General Practice Dentistry
  • San Diego, CA
National Provider Identifier
1568037984
Registry record updated Nov 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
107966 Issued in CA
Practice address
4060 Fairmount Ave 3Rd Floor
Dental Department
San Diego, CA 92105-9210
Phone
(619) 564-7018
Fax
(619) 795-9848
NPI assigned
May 27, 2021
Last updated
Nov 23, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 23, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 107966 CA Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

4060 Fairmount Ave 3Rd Floor
Dental Department
San Diego, CA 92105-9210

Mailing address

6507 21St Ave NE
Seattle, WA 98115-6947
Phone (805) 990-9115

Other names 1

  • Pejman Behinaein Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230620000924 CA Practitioner - Dentist 8426416769 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
107966CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
La Maestra Family Clinic Inc CurrentSince May 1, 2023 Accepting new patients
La Maestra Family Clinic, Inc. Multi-Specialty Current Accepting new patients
La Maestra Family Clinic, Inc. CurrentSince May 1, 2023 Accepting new patients

Locations

1032 Broadway
El Cajon, CA 92021
Phone (619) 402-5653

165 S 1st St
El Cajon, CA 92019
Phone (619) 312-0347

4060 Fairmount Ave
San Diego, CA 92105
Phone (619) 255-9155

4060 Fairmount Ave
Fl 3
San Diego, CA 92105
Phone (619) 564-7018

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1622073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669161600000",
    "number": "1568037984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6507 21ST AVE NE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981156947",
            "telephone_number": "805-990-9115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 FAIRMOUNT AVE 3RD FLOOR",
            "address_2": "DENTAL DEPARTMENT",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921059210",
            "telephone_number": "619-564-7018",
            "fax_number": "619-795-9848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEHIN",
        "first_name": "PEJMAN",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-05-27",
        "last_updated": "2022-11-23",
        "certification_date": "2022-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "107966",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PEJMAN",
            "last_name": "BEHINAEIN",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.