Provider Demographics
NPI:1609987924
Name:PANDURANGI, KESHAV K (MD)
Entity Type:Individual
Prefix:
First Name:KESHAV
Middle Name:K
Last Name:PANDURANGI
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 1:2637 SHADELANDS DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2512
Mailing Address - Country:US
Mailing Address - Phone:925-932-6330
Mailing Address - Fax:925-932-0139
Practice Address - Street 1:2637 SHADELANDS DR
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2512
Practice Address - Country:US
Practice Address - Phone:925-932-6330
Practice Address - Fax:925-932-0139
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA901872086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A901870Medicaid
CA00A901871Medicaid
CA00A901870Medicare PIN
CA00A901870Medicaid
CA00A901871Medicare PIN