Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A100278 | CA |
Y | 207QS0010X | Family Doctor - Sports Medicine | 100278 | CA |
NPI | 1215137815 |
---|---|
Provider Name | Sandeep Gupta |
First Address | Santa Clara, CA 95051-5173 |
Second Address | Fremont, CA 94538-2101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2007 |
Last Update Date | 11/02/2022 |