Provider Demographics
NPI:1003207747
Name:DESAI, KHUSHBU SHRINANDKUMAR (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KHUSHBU
Middle Name:SHRINANDKUMAR
Last Name:DESAI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4319 RENAISSANCE DR
Mailing Address - Street 2:APT#306
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-2828
Mailing Address - Country:US
Mailing Address - Phone:919-649-6090
Mailing Address - Fax:
Practice Address - Street 1:4949 STEVENS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-6661
Practice Address - Country:US
Practice Address - Phone:408-260-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA52177363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant