Provider Demographics
NPI:1962518357
Name:DESAI, VIRENDRA M (MD)
Entity type:Individual
Prefix:DR
First Name:VIRENDRA
Middle Name:M
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:AADISAI MEDICAL GROUP, INC.
Mailing Address - Street 2:5451 LA PALMA AVE # 43
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1728
Mailing Address - Country:US
Mailing Address - Phone:714-523-0000
Mailing Address - Fax:714-523-0011
Practice Address - Street 1:AADISAI MEDICAL GROUP, INC.
Practice Address - Street 2:5451 LA PALMA AVE # 43
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1728
Practice Address - Country:US
Practice Address - Phone:714-523-0000
Practice Address - Fax:714-523-0011
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAFNP34276207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18835Medicare ID - Type UnspecifiedGROUP MEDICARE ID
CAA29673Medicare UPIN
CAWA43192HMedicare ID - Type UnspecifiedPROVIDER MEDICARE ID