Provider Demographics
NPI:1861428104
Name:BINAEI, KAYVAN (PA)
Entity type:Individual
Prefix:MR
First Name:KAYVAN
Middle Name:
Last Name:BINAEI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7244 SHORELINE DR UNIT 144
Mailing Address - Street 2:UNIT 144
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-4932
Mailing Address - Country:US
Mailing Address - Phone:619-543-0144
Mailing Address - Fax:619-543-0445
Practice Address - Street 1:3549 CAMINO DEL RIO S
Practice Address - Street 2:SUITE A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4023
Practice Address - Country:US
Practice Address - Phone:619-543-0144
Practice Address - Fax:619-543-0445
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA 16285363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPA16285AMedicare PIN