Provider Demographics
NPI:1831245810
Name:GUPTA, PAWAN KUMAR (MD)
Entity type:Individual
Prefix:
First Name:PAWAN
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 1:300 W PUEBLO ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4311
Mailing Address - Country:US
Mailing Address - Phone:805-682-7300
Mailing Address - Fax:808-898-3616
Practice Address - Street 1:601 W JUNIPERO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4213
Practice Address - Country:US
Practice Address - Phone:805-898-2187
Practice Address - Fax:805-563-4440
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA953988174400000X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM70596FMedicaid
CAG39709Medicare UPIN
CACC560WMedicare PIN
CAW13890Medicare ID - Type Unspecified