MEDICARE: KRISHNA KISHORE BEZWADA MD

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	2084P0800X	Psychiatry Physician	251956	NY
2	390200000X	Student in an Organized Health Care Education/Training Program	0116016255	VA
3	2084P0800X	Psychiatry Physician	C167815	CA

General Provider Information

NPI Number	:	1346458478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISHNA KISHORE BEZWADA MD

Provider Business Mailing Address
First Line	:	377 TOBRURRY WAY
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-6336
Country	:	US
Telephone Number	:	516-984-1646
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 SUNCAST LN STE 108
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-9335
Country	:	US
Telephone Number	:	916-932-0378
Fax Number	:

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	01/22/2025

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