MEDICARE: KAVITA DARJI PATEL M.D.

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	207N00000X	Dermatology Physician	187264	CA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1558894675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAVITA DARJI PATEL M.D.

Provider Business Mailing Address
First Line	:	12700 PARK CENTRAL DR STE 1210
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-1522
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30201 GOLDEN LANTERN STE B
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-5926
Country	:	US
Telephone Number	:	949-363-1788
Fax Number	:	949-363-1607

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

Provider Enumeration Date	:	04/05/2017
Last Update Date	:	05/04/2026

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