Provider Demographics
NPI:1295751824
Name:BHENDE, KISHORE (MD)
Entity type:Individual
Prefix:
First Name:KISHORE
Middle Name:
Last Name:BHENDE
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 1:600 COFFEE RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4201
Mailing Address - Country:US
Mailing Address - Phone:209-524-1211
Mailing Address - Fax:
Practice Address - Street 1:2505 W HAMMER LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-2839
Practice Address - Country:US
Practice Address - Phone:209-957-7050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68082207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB49158Medicare UPIN
CA00A405798Medicare PIN
CAZZZ15998ZMedicare PIN
CA00A4057910Medicare PIN
CACD4582Medicare PIN
CAZZZ21365ZMedicare PIN
CAZZZ34009ZMedicare PIN
CA00A405794Medicare PIN
CA00A405797Medicare PIN
CA00A405793Medicare PIN
CA00A405799Medicare PIN
CAZZZ21366ZMedicare PIN
CAZZZ21367ZMedicare PIN
CAP00438767Medicare PIN
CAZZZ15999ZMedicare PIN