Provider Demographics
NPI:1396990560
Name:GUPTA, ANKUR VED (MD)
Entity type:Individual
Prefix:
First Name:ANKUR
Middle Name:VED
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 1:5211 W GOSHEN AVE # 125
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-8619
Mailing Address - Country:US
Mailing Address - Phone:559-624-4080
Mailing Address - Fax:
Practice Address - Street 1:820 S AKERS ST STE 130
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-8346
Practice Address - Country:US
Practice Address - Phone:559-624-6520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108509207RC0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001477934Medicaid
CT001477934Medicaid
CTD400003769 - C00814Medicare PIN