Provider Demographics
NPI:1558627182
Name:DESAI, AMIT D (MD)
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:D
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:398 ORTEGA AVE UNIT 145
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6213
Mailing Address - Country:US
Mailing Address - Phone:858-361-2113
Mailing Address - Fax:
Practice Address - Street 1:441 N CENTRAL AVE STE 6
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1428
Practice Address - Country:US
Practice Address - Phone:858-361-2113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA1817362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty