Healthcare Provider Details

I. General information

NPI: 1215994736
Provider Name (Legal Business Name): SURESH K SACHDEVA MD PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 MARKET PLACE SUITE 800
SAN RAMON CA
94583-4750
US

IV. Provider business mailing address

1081 MARKET PLACE SUITE 800
SAN RAMON CA
94583-4750
US

V. Phone/Fax

Practice location:
  • Phone: 925-275-0404
  • Fax: 925-275-0488
Mailing address:
  • Phone: 925-275-0404
  • Fax: 925-275-0488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA42843
License Number StateCA

VIII. Authorized Official

Name: MR. SURESH K SACHDEVA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 925-275-0404