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NPI Code Detail

MEDICARE: DR. HEALTHY JAYANTILAL DESAI M.D.

MEDICARE: DR. HEALTHY JAYANTILAL DESAI 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
1207X00000XOrthopaedic Surgery PhysicianA114098CA
2390200000XStudent in an Organized Health Care Education/Training ProgramP65752NY
3390200000XStudent in an Organized Health Care Education/Training ProgramBP10035982TX
4207XX0005XSports Medicine (Orthopaedic Surgery) PhysicianA114098CA

General Provider Information

NPI Number : 1639327315
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HEALTHY JAYANTILAL DESAI M.D.
Provider Business Mailing Address
First Line : 1081 N CHINA LAKE BLVD
Second Line :
City : RIDGECREST
State : CA
Zip : 93555-3130
Country : US
Telephone Number : 760-446-8692
Fax Number : 760-446-8694
Provider Business Practice Location Address
First Line : 1041 N CHINA LAKE BLVD
Second Line : B
City : RIDGECREST
State : CA
Zip : 93555-3183
Country : US
Telephone Number : 760-446-6404
Fax Number : 760-446-6415
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2008
Last Update Date : 05/17/2021

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