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General NPI Number Information
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NPI Number | 1427084839
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Entity Type | Individual
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Provider Name | KISHORE K DESAGANI M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 101 E VALENCIA MESA DR
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City | FULLERTON
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State | CA
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Zip | 92835-3809
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Country | US
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Telephone | 949-689-0288
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Fax | 949-509-6599
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Provider Business Mailing Address
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Address Line | 4199 CAMPUS DR STE 550
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City | IRVINE
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State | CA
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Zip | 92612-4694
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Country | US
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Telephone | 949-689-0288
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Fax | 949-509-6599
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A99666
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License Number State | CA
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