Individual ProviderYashaswi KoguruStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address809 82nd Pkwy Grand Stand Medical Center, Myrtle Beach, SC 29572(843) 692-1118PECOS EnrollmentBased on the most recent information from CMS, provider Yashaswi Koguru does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 11:05 AM.Profile DetailsProvider ID1891543872Provider TypeIndividualFull NameKoguru, YashaswiCredentialM.D.GenderFemaleSole ProprietorNoEnumeration Date5/7/2024Last Updated9/20/2024Contact InformationPractice LocationPractice Address809 82nd Pkwy Grand Stand Medical Center, Myrtle Beach, SC 29572Phone(843) 692-1118Fax(843) 692-1122Mailing LocationMailing Address809 82nd Pkwy Grand Stand Medical Center, Gme Office, Myrtle Beach, SC 29572Phone(843) 692-1118Fax(843) 692-1122Provider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer