Provider Demographics
NPI:1972754927
Name:KESHAVARZI, SASSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SASSAN
Middle Name:
Last Name:KESHAVARZI
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 1:2701 CHESTER AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2016
Mailing Address - Country:US
Mailing Address - Phone:844-637-8363
Mailing Address - Fax:844-637-8332
Practice Address - Street 1:1415 TULANE AVE FL 5
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2600
Practice Address - Country:US
Practice Address - Phone:504-988-5263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99882207T00000X
LA332737207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA176642OtherPTAN
GA003125355AMedicaid
FL005823100Medicaid
FL14L8SOtherBCBS
FLGG842ZMedicare PIN
CA176642OtherPTAN
FL005823100Medicaid