Provider Demographics
NPI:1730602921
Name:KAYASTHA, SAURAV N (MD)
Entity type:Individual
Prefix:
First Name:SAURAV
Middle Name:N
Last Name:KAYASTHA
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 1:1008 ROYAL BIRKDALE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4474
Mailing Address - Country:US
Mailing Address - Phone:254-239-8776
Mailing Address - Fax:331-204-0819
Practice Address - Street 1:221 1ST AVE W STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-4223
Practice Address - Country:US
Practice Address - Phone:888-782-7114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD.70030858208D00000X
MO2017015685363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical