Healthcare Provider Details

I. General information

NPI: 1124558267
Provider Name (Legal Business Name): DMITRY DMITRIYEVICH BELCHENKO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7257 N FRESNO ST
FRESNO CA
93720-2950
US

IV. Provider business mailing address

7257 N FRESNO ST
FRESNO CA
93720-2950
US

V. Phone/Fax

Practice location:
  • Phone: 559-227-7463
  • Fax: 559-451-3690
Mailing address:
  • Phone: 559-227-7463
  • Fax: 559-451-3690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number19737
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: