Provider Demographics
NPI:1346328499
Name:GUHA, AMAL KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:AMAL
Middle Name:KUMAR
Last Name:GUHA
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 1:16124 KASOTA RD
Mailing Address - Street 2:STE A & B
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2216
Mailing Address - Country:US
Mailing Address - Phone:760-242-2099
Mailing Address - Fax:760-242-5065
Practice Address - Street 1:16124 KASOTA RD
Practice Address - Street 2:STE A & B
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2216
Practice Address - Country:US
Practice Address - Phone:760-242-2099
Practice Address - Fax:760-242-5065
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35044207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A350440Medicaid
A27667Medicare UPIN
CA00A350440Medicaid