Healthcare Provider Details

I. General information

NPI: 1932150836
Provider Name (Legal Business Name): KIRTIKUMAR GOPALJI DESAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 SOQUEL DR
SANTA CRUZ CA
95065-1705
US

IV. Provider business mailing address

PO BOX 49168
SAN JOSE CA
95161-9168
US

V. Phone/Fax

Practice location:
  • Phone: 831-462-7700
  • Fax:
Mailing address:
  • Phone: 503-372-2740
  • Fax: 503-372-2754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG65930
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: