Healthcare Provider Details

I. General information

NPI: 1619534617
Provider Name (Legal Business Name): LAVINA VIJAY DESAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2019
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date: 01/27/2020
Reactivation Date: 02/13/2020

III. Provider practice location address

2401 GILLHAM RD
KANSAS CITY MO
64108-4619
US

IV. Provider business mailing address

2401 GILLHAM RD ATTN PROVIDER ENROLLMENT DEPT
KANSAS CITY MO
64108-4619
US

V. Phone/Fax

Practice location:
  • Phone: 816-234-3000
  • Fax:
Mailing address:
  • Phone: 816-701-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number2023008213
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: