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General NPI Number Information
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NPI Number | 1215161906
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Entity Type | Organization
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Legal Business Name | KUSUM DIPAK DESAI MD CHARTERED
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Dates
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Enumeration Date | 05/08/2009
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Last Update Date | 02/19/2010
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Provider Practice Location Address
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Address Line | 6450 MEDICAL CENTER ST STE 4
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City | LAS VEGAS
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State | NV
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Zip | 89148-2405
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Country | US
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Telephone | 702-739-9518
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Fax |
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Provider Business Mailing Address
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Address Line | 9811 W CHARLESTON BLVD STE 2857
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City | LAS VEGAS
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State | NV
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Zip | 89117-7528
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KUSUM DESAI
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Credential | MD
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Telephone | 702-306-4691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 4051
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License Number State | NV
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