Provider Demographics
NPI:1275732091
Name:BOPARAI, GURPREET KAUR (MD)
Entity type:Individual
Prefix:
First Name:GURPREET
Middle Name:KAUR
Last Name:BOPARAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 CAMINO RAMON STE 180
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-2060
Mailing Address - Country:US
Mailing Address - Phone:925-866-1005
Mailing Address - Fax:
Practice Address - Street 1:2301 CAMINO RAMON STE 180
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-2060
Practice Address - Country:US
Practice Address - Phone:925-866-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC168956207Q00000X
MO2010020916207Q00000X
IL036-134430207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400121401Medicare PIN