MEDICARE: KATIE BESANKO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	66807	CA

General Provider Information

NPI Number	:	1114638053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE BESANKO

Provider Business Mailing Address
First Line	:	1762 WESTWOOD BLVD STE 320
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-5641
Country	:	US
Telephone Number	:	413-455-8555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1762 WESTWOOD BLVD STE 320
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-5641
Country	:	US
Telephone Number	:	413-455-8555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2022
Last Update Date	:	02/18/2026

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Directions to “ KATIE BESANKO ” Practice Location

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