Healthcare Provider Details

I. General information

NPI: 1730602921
Provider Name (Legal Business Name): SAURAV N KAYASTHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 1ST AVE W STE 200
SEATTLE WA
98119-4223
US

IV. Provider business mailing address

1008 ROYAL BIRKDALE DR
COLUMBIA MO
65203-4474
US

V. Phone/Fax

Practice location:
  • Phone: 888-782-7114
  • Fax:
Mailing address:
  • Phone: 254-239-8776
  • Fax: 331-204-0819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2017015685
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD.70030858
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: