Provider Demographics
NPI:1215994736
Name:SURESH K SACHDEVA MD PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SURESH K SACHDEVA MD PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:K
Authorized Official - Last Name:SACHDEVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-275-0404
Mailing Address - Street 1:1081 MARKET PLACE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4750
Mailing Address - Country:US
Mailing Address - Phone:925-275-0404
Mailing Address - Fax:925-275-0488
Practice Address - Street 1:1081 MARKET PLACE
Practice Address - Street 2:SUITE 800
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4750
Practice Address - Country:US
Practice Address - Phone:925-275-0404
Practice Address - Fax:925-275-0488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42843208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1215994736Medicaid
CA00A428431Medicaid