Provider Demographics
NPI:1851890453
Name:DESAI, TUSHAR K (MD)
Entity Type:Individual
Prefix:
First Name:TUSHAR
Middle Name:K
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KEAHOLE PL APT 1202
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-3420
Mailing Address - Country:US
Mailing Address - Phone:818-675-8531
Mailing Address - Fax:
Practice Address - Street 1:1 KEAHOLE PL APT 1202
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-3420
Practice Address - Country:US
Practice Address - Phone:818-675-8531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31524207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH01527814OtherDRIVER'S LICENSE
AD7878878OtherDEA