Healthcare Provider Details

I. General information

NPI: 1124015706
Provider Name (Legal Business Name): AJAY DESAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 TRUXTUN AVE
BAKERSFIELD CA
93309-0633
US

IV. Provider business mailing address

10608 PETALO DR
BAKERSFIELD CA
93311-2284
US

V. Phone/Fax

Practice location:
  • Phone: 661-322-2206
  • Fax: 661-327-7027
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG85497
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberG85497
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: