Provider Demographics
NPI:1346458478
Name:BEZWADA, KRISHNA KISHORE (MD)
Entity Type:Individual
Prefix:
First Name:KRISHNA
Middle Name:KISHORE
Last Name:BEZWADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 ROGERS CIR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-7753
Mailing Address - Country:US
Mailing Address - Phone:516-984-1646
Mailing Address - Fax:
Practice Address - Street 1:1020 SUNCAST LN STE 108
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9335
Practice Address - Country:US
Practice Address - Phone:916-932-0378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2519562084P0800X
VA0116016255390200000X
CAC1678152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program