Provider Demographics
NPI:1780603514
Name:BHAT, BALA KRISHNA (MD)
Entity type:Individual
Prefix:
First Name:BALA
Middle Name:KRISHNA
Last Name:BHAT
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 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8028
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:260 STATION WAY
Practice Address - Street 2:SUITE A
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3359
Practice Address - Country:US
Practice Address - Phone:805-481-3652
Practice Address - Fax:805-481-1017
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43451207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1447277488OtherCMC NPI#
CAHAP70593FOtherFAMILY PLANNING
CAFHC70593FMedicaid
CA1780603514OtherNPPES
CAW1508OtherMEDICARE GROUP PLAN
CA1447277488OtherCMC NPI#
CACQ689YMedicare PIN
CAHAP70593FOtherFAMILY PLANNING
CA1780603514OtherNPPES
CAE25206Medicare UPIN
CAWA43451AMedicare PIN
CACQ689ZZMedicare PIN