Active NPI
Vadim V Bezzubchenko, MT
- Specialist
- Walnut Creek, CA
National Provider Identifier
1205965894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 039718
- Practice address
- 1661 Botelho Dr Ste 290
Walnut Creek, CA 94596-5066 - Phone
- (925) 979-1020
- NPI assigned
- Mar 2, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 039718 | CA | Primary |
Addresses
Primary practice location
1661 Botelho Dr Ste 290
Walnut Creek, CA 94596-5066
Mailing address
647 Preakness Dr
Walnut Creek, CA 94597-3688
Phone (925) 210-1053
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 039718 | CA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205965894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "647 PREAKNESS DR",
"city": "WALNUT CREEK",
"state": "CA",
"postal_code": "945973688",
"telephone_number": "925-210-1053"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1661 BOTELHO DR STE 290",
"city": "WALNUT CREEK",
"state": "CA",
"postal_code": "945965066",
"telephone_number": "925-979-1020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEZZUBCHENKO",
"first_name": "VADIM",
"middle_name": "V",
"name_prefix": "Mr.",
"credential": "MT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "039718",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Walnut Creek, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.