Healthcare Provider Details

I. General information

NPI: 1952043440
Provider Name (Legal Business Name): KYNOOSH SERAJI MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATIE SERAJI MS, CGC

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7202 N MILLBROOK AVE STE 209
FRESNO CA
93720-3341
US

IV. Provider business mailing address

1111 E SPRUCE AVE STE 431
FRESNO CA
93720-3330
US

V. Phone/Fax

Practice location:
  • Phone: 559-450-5519
  • Fax:
Mailing address:
  • Phone: 559-450-7449
  • Fax: 559-450-7470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGEN-GEN-LIC-000471
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC001771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: