Provider Demographics
NPI:1083659528
Name:GUHA ROY, ASIM (MD)
Entity Type:Individual
Prefix:DR
First Name:ASIM
Middle Name:
Last Name:GUHA ROY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8861 VILLA LA JOLLA DR # 13484
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1918
Mailing Address - Country:US
Mailing Address - Phone:619-417-1500
Mailing Address - Fax:
Practice Address - Street 1:4540 KEARNY VILLA RD STE 106
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1564
Practice Address - Country:US
Practice Address - Phone:619-417-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAO62010207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA62010Medicare ID - Type Unspecified
CA99059Medicare UPIN