Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | BP10034801 | TX |
Y | 2080P0202X | Pediatric Cardiologist | 04-37769 | KS |
NPI | 1093945172 |
---|---|
Provider Name | Pooja Desai |
First Address | Wichita, KS 67201-7490 |
Second Address | Wichita, KS 67208-3052 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2009 |
Last Update Date | 27/01/2022 |