Healthcare Provider Details

I. General information

NPI: 1962476960
Provider Name (Legal Business Name): DEVANSHU HARENDRA THAKORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 N CHINA LAKE BLVD
RIDGECREST CA
93555-3130
US

IV. Provider business mailing address

1081 N CHINA LAKE BLVD
RIDGECREST CA
93555-3130
US

V. Phone/Fax

Practice location:
  • Phone: 760-446-3551
  • Fax: 760-446-2254
Mailing address:
  • Phone: 760-499-3899
  • Fax: 760-446-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberC128303
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: