Provider Demographics
NPI:1871500389
Name:DESAI, ANANT J (MD)
Entity Type:Individual
Prefix:DR
First Name:ANANT
Middle Name:J
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANANT
Other - Middle Name:J
Other - Last Name:DESAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:26853 ALCOTT CT
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10605 BALBOA BLVD
Practice Address - Street 2:240
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6342
Practice Address - Country:US
Practice Address - Phone:818-366-4626
Practice Address - Fax:818-366-4630
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72186207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH20748Medicare UPIN