Provider Demographics
NPI:1407902331
Name:GUPTA, VINOD K (MD)
Entity Type:Individual
Prefix:DR
First Name:VINOD
Middle Name:K
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 1:100 WILLOW PLZ STE 200
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6213
Mailing Address - Country:US
Mailing Address - Phone:559-733-7010
Mailing Address - Fax:559-733-3671
Practice Address - Street 1:100 WILLOW PLZ STE 200
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6213
Practice Address - Country:US
Practice Address - Phone:559-733-7010
Practice Address - Fax:559-733-3671
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45899174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A458990Medicaid
CA00A458990Medicaid
CA00A458990Medicare PIN