Provider Demographics
NPI:1437389327
Name:PAKSERESHT, SEYED KAVOUS (MD)
Entity Type:Individual
Prefix:
First Name:SEYED
Middle Name:KAVOUS
Last Name:PAKSERESHT
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 1:5601 NORRIS CANYON RD STE 240
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-5407
Mailing Address - Country:US
Mailing Address - Phone:925-901-1303
Mailing Address - Fax:925-901-1302
Practice Address - Street 1:5601 NORRIS CANYON RD STE 240
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5407
Practice Address - Country:US
Practice Address - Phone:925-901-1303
Practice Address - Fax:925-901-1302
Is Sole Proprietor?:No
Enumeration Date:2009-07-25
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9407298207RG0100X
WAMD60638477207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8958206OtherMEDICARE-KING COUNTY