Provider Demographics
NPI:1477510428
Name:BEIZAI, KRISTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:
Last Name:BEIZAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13335 WINSTANLEY WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-1403
Mailing Address - Country:US
Mailing Address - Phone:858-703-4029
Mailing Address - Fax:
Practice Address - Street 1:3350 VIA LA JOLLA
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0001
Practice Address - Country:US
Practice Address - Phone:858-642-3686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN292022084P0800X
CAA626582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G14905Medicare UPIN
3821187Medicare ID - Type Unspecified
TN3821189Medicare ID - Type Unspecified