Healthcare Provider Details

I. General information

NPI: 1962776245
Provider Name (Legal Business Name): BRIAN J KEYASHIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2012
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2637 SHADELANDS DR STE A
WALNUT CREEK CA
94598-2512
US

IV. Provider business mailing address

2637 SHADELANDS DR
WALNUT CREEK CA
94598-2512
US

V. Phone/Fax

Practice location:
  • Phone: 925-932-6330
  • Fax: 925-932-0139
Mailing address:
  • Phone: 925-932-6330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125.058017
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA147947
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: