Provider Demographics
NPI:1184882904
Name:GUPTA, ANSHU KUMAR (MD)
Entity type:Individual
Prefix:MR
First Name:ANSHU
Middle Name:KUMAR
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 1:700 GARDEN VIEW CT STE 208
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2478
Mailing Address - Country:US
Mailing Address - Phone:760-436-7600
Mailing Address - Fax:760-436-7606
Practice Address - Street 1:700 GARDEN VIEW CT STE 208
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2478
Practice Address - Country:US
Practice Address - Phone:760-436-7600
Practice Address - Fax:760-436-7606
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87872208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABU648AMedicare UPIN
CABU651ZMedicare UPIN