Healthcare Provider Details

I. General information

NPI: 1841495728
Provider Name (Legal Business Name): KUMAR SUBODH DESAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 W JANSS RD STE 125
THOUSAND OAKS CA
91360-1856
US

IV. Provider business mailing address

227 W JANSS RD STE 125
THOUSAND OAKS CA
91360-1856
US

V. Phone/Fax

Practice location:
  • Phone: 805-449-4278
  • Fax:
Mailing address:
  • Phone: 805-449-4278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberA115599
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA115599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: