Individual
DESMOND ADRIAN SJAUWFOEKLOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1010 W LA VETA AVE STE 750, ORANGE, CA 92868-4312
(714) 639-9401
(714) 919-8804
Mailing address
24422 AVENIDA DE LA CARLOTA, STE 275, LAGUNA HILLS, CA 92653-3669
(714) 639-9401
(714) 919-8804
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A74658
CA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
A74658
CA
207RP1001X
Pulmonary Disease Physician
A74658
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1912919804
NPI - TYPE 2
—
05
—
1912919804
—
CA
01
—
A74658
STATE MEDICAL LICENSE
CA
01
—
CG5665
RAILROAD MEDICARE - GROUP PIN
CA
01
—
GR0003350
MEDICAID - GROUP PROVIDER
CA
01
—
P00986419
RAILROAD MEDICARE INDIVIDUAL PIN
CA
01
—
W1514
MEDICARE PTAN - TYPE 2
CA
Enumeration date
11/29/2006
Last updated
07/21/2022
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