Provider Demographics
NPI:1326005422
Name:SACHDEVA, SURESH K (MD)
Entity Type:Individual
Prefix:
First Name:SURESH
Middle Name:K
Last Name:SACHDEVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1081 MARKET PL STE 800
Mailing Address - Street 2:
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 PL
Practice Address - Street 2:#800
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4773
Practice Address - Country:US
Practice Address - Phone:925-275-0404
Practice Address - Fax:925-275-0488
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42843208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A428431Medicaid
CAE72047Medicare UPIN