Healthcare Provider Details

I. General information

NPI: 1467715748
Provider Name (Legal Business Name): KAVITA P. DESHPANDE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18785 S. BROOKHURST ST., SUITE #200
FOUNTAIN VALLEY CA
92708
US

IV. Provider business mailing address

18785 S. BROOKHURST ST., SUITE #200
FOUNTAIN VALLEY CA
92708
US

V. Phone/Fax

Practice location:
  • Phone: 714-378-5330
  • Fax: 714-378-5320
Mailing address:
  • Phone: 714-378-5330
  • Fax: 714-378-5320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA154882
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: