MEDICARE: DR. JESSICA SAURABH DESAI

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	108105	CA

General Provider Information

NPI Number	:	1558084913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA SAURABH DESAI

Provider Business Mailing Address
First Line	:	8303 E ARROWHEAD WAY
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92808-2374
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8303 E ARROWHEAD WAY
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92808-2374
Country	:	US
Telephone Number	:	714-213-3929
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2022
Last Update Date	:	09/21/2022

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