Provider Demographics
NPI:1265006043
Name:BEKKAM, SOWMYA SHREE (MD)
Entity type:Individual
Prefix:
First Name:SOWMYA
Middle Name:SHREE
Last Name:BEKKAM
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 CAMINO RAMON
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1354
Mailing Address - Country:US
Mailing Address - Phone:925-244-7600
Mailing Address - Fax:
Practice Address - Street 1:2300 CAMINO RAMON
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1354
Practice Address - Country:US
Practice Address - Phone:925-244-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301512911207Q00000X
FLME170964207Q00000X
CAA201294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine