MEDICARE: RAJIV N DESAI DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	32294	CA

General Provider Information

NPI Number	:	1104212059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAJIV N DESAI DDS INC

Provider Business Mailing Address
First Line	:	1212 S BRISTOL ST STE 17C
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-3439
Country	:	US
Telephone Number	:	714-850-1211
Fax Number	:	714-850-9094

Provider Business Practice Location Address
First Line	:	1212 S BRISTOL ST STE 17C
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-3439
Country	:	US
Telephone Number	:	714-850-1211
Fax Number	:	714-850-9094

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. RAJIV N DESAI
Credential	:	DDS
Telephone Number	:	714-850-1211

Provider Enumeration Date	:	04/07/2015
Last Update Date	:	04/07/2015

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