Provider Demographics
NPI:1750466298
Name:DESAI, ASHA KAUSHIK (MD)
Entity type:Individual
Prefix:DR
First Name:ASHA
Middle Name:KAUSHIK
Last Name:DESAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1111 EXPOSITION BLVD BLDG 700
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4314
Mailing Address - Country:US
Mailing Address - Phone:916-736-3399
Mailing Address - Fax:916-233-4171
Practice Address - Street 1:1528 EUREKA RD STE 102
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3047
Practice Address - Country:US
Practice Address - Phone:916-736-3399
Practice Address - Fax:916-736-3350
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA00039587174400000X
CAA39587207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A395870Medicaid
CAA28913Medicare UPIN
CA00A395872Medicare ID - Type Unspecified
CA00A395870Medicaid