Provider Demographics
NPI:1568037984
Name:BEHIN, PEJMAN (DDS)
Entity Type:Individual
Prefix:
First Name:PEJMAN
Middle Name:
Last Name:BEHIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:PEJMAN
Other - Middle Name:
Other - Last Name:BEHINAEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:6507 21ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6947
Mailing Address - Country:US
Mailing Address - Phone:805-990-9115
Mailing Address - Fax:
Practice Address - Street 1:4060 FAIRMOUNT AVE 3RD FLOOR
Practice Address - Street 2:DENTAL DEPARTMENT
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-9210
Practice Address - Country:US
Practice Address - Phone:619-564-7018
Practice Address - Fax:619-795-9848
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1079661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty