Provider Demographics
NPI:1770737017
Name:BEZRUKOV, NIKITA V (MD)
Entity type:Individual
Prefix:DR
First Name:NIKITA
Middle Name:V
Last Name:BEZRUKOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NIKITA
Other - Middle Name:
Other - Last Name:BEZRUKIY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2180 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1625
Mailing Address - Country:US
Mailing Address - Phone:808-242-6464
Mailing Address - Fax:
Practice Address - Street 1:1310 W STEWART DR STE 410
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3855
Practice Address - Country:US
Practice Address - Phone:714-538-8549
Practice Address - Fax:714-538-1547
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-17786207X00000X
CAA111624207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery