Provider Demographics
NPI:1831126689
Name:GUPTA, RAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJ
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAJ
Other - Middle Name:
Other - Last Name:KUMAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:200 JOSE FIGUERES AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1586
Mailing Address - Country:US
Mailing Address - Phone:408-347-1600
Mailing Address - Fax:408-347-0600
Practice Address - Street 1:200 JOSE FIGUERES AVE
Practice Address - Street 2:STE 200
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1586
Practice Address - Country:US
Practice Address - Phone:408-347-1600
Practice Address - Fax:408-347-0600
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA938542084N0400X
MIL7762652084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology