Provider Demographics
NPI:1134300866
Name:BINA, PEDRAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:PEDRAM
Middle Name:
Last Name:BINA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 S BEVERLY GLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-2548
Mailing Address - Country:US
Mailing Address - Phone:310-433-2722
Mailing Address - Fax:
Practice Address - Street 1:559 S BEVERLY GLEN BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-2548
Practice Address - Country:US
Practice Address - Phone:310-433-2722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-22
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA566491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice