Provider Demographics
NPI:1952043440
Name:SERAJI, KYNOOSH (MS, CGC)
Entity Type:Individual
Prefix:
First Name:KYNOOSH
Middle Name:
Last Name:SERAJI
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:SERAJI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:1111 E SPRUCE AVE STE 431
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3330
Mailing Address - Country:US
Mailing Address - Phone:559-450-7449
Mailing Address - Fax:559-450-7470
Practice Address - Street 1:7202 N MILLBROOK AVE STE 209
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3341
Practice Address - Country:US
Practice Address - Phone:559-450-5519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTGEN-GEN-LIC-000471170300000X
AR170300000X
CAGC001771170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS