Provider Demographics
NPI:1659812857
Name:SOTOUDEH, KAYVON (MD)
Entity type:Individual
Prefix:
First Name:KAYVON
Middle Name:
Last Name:SOTOUDEH
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 1:1133 E STANLEY BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4246
Mailing Address - Country:US
Mailing Address - Phone:925-454-6390
Mailing Address - Fax:
Practice Address - Street 1:1133 E STANLEY BLVD STE 207
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4246
Practice Address - Country:US
Practice Address - Phone:925-373-4129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA158367207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine