Provider Demographics
NPI:1316042948
Name:CHANANA GUPTA, ANJALI (MD)
Entity Type:Individual
Prefix:
First Name:ANJALI
Middle Name:
Last Name:CHANANA GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANJALI
Other - Middle Name:
Other - Last Name:CHANANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2025 MORSE AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2115
Mailing Address - Country:US
Mailing Address - Phone:916-973-5734
Mailing Address - Fax:
Practice Address - Street 1:2025 MORSE AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2115
Practice Address - Country:US
Practice Address - Phone:916-973-5734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 70197207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANPI 1992038285OtherPTAN CO499A
CAA70197OtherMEDICAL LICENSE
CANPI 1992038285OtherPTAN CO499A