Healthcare Provider Details

I. General information

NPI: 1881988830
Provider Name (Legal Business Name): KUMAR DESAI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 W JANSS RD SUITE 315
THOUSAND OAKS CA
91360-1848
US

IV. Provider business mailing address

227 W JANSS RD SUITE 315
THOUSAND OAKS CA
91360-1848
US

V. Phone/Fax

Practice location:
  • Phone: 805-449-4278
  • Fax: 805-449-4277
Mailing address:
  • Phone: 805-449-4278
  • Fax: 805-449-4277

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: DR. KUMAR S DESAI
Title or Position: PRESIDENT
Credential: MD
Phone: 805-449-4278