Provider Demographics
NPI:1811088339
Name:PATEL, DAKSHESH BHULABHAI (MD)
Entity type:Individual
Prefix:
First Name:DAKSHESH
Middle Name:BHULABHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAKSHESHKUMAR
Other - Middle Name:B
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-8541
Mailing Address - Fax:323-442-8755
Practice Address - Street 1:1500 SAN PABLO ST FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5313
Practice Address - Country:US
Practice Address - Phone:323-442-8541
Practice Address - Fax:323-442-8755
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA958682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-110472OtherILLINOIS- IDFPR
CAA95868OtherMEDI-CAL LICENSE
CA00A958680Medicaid
BP9766049OtherDEA
CA00A958680OtherBLUE SHIELD
1811088339OtherNPPES
CA00A958680Medicaid
CAWAMedicare PIN
CAI62906Medicare UPIN
CAWA95868DMedicare PIN
CAWA95868BMedicare PIN
IL036-110472OtherILLINOIS- IDFPR