Provider Demographics
NPI:1083854582
Name:GUPTA, ANKUR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANKUR
Middle Name:
Last Name:GUPTA
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:PO BOX 3672
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-0672
Mailing Address - Country:US
Mailing Address - Phone:650-224-8977
Mailing Address - Fax:
Practice Address - Street 1:701 E 28TH ST STE 314
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2702
Practice Address - Country:US
Practice Address - Phone:562-981-9308
Practice Address - Fax:562-981-9318
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104116208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery