Healthcare Provider Details

I. General information

NPI: 1154555340
Provider Name (Legal Business Name): SESHADRI KASTURI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 K ST SUITE 200
SACRAMENTO CA
95816-5120
US

IV. Provider business mailing address

2801 K ST SUITE 200
SACRAMENTO CA
95816-5120
US

V. Phone/Fax

Practice location:
  • Phone: 916-779-1160
  • Fax: 916-779-1166
Mailing address:
  • Phone: 916-779-1160
  • Fax: 916-779-1166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License NumberA121695
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: