Healthcare Provider Details

I. General information

NPI: 1326005422
Provider Name (Legal Business Name): SURESH K SACHDEVA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 MARKET PL #800
SAN RAMON CA
94583-4773
US

IV. Provider business mailing address

1081 MARKET PL STE 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:
Title or Position:
Credential:
Phone: