Provider Demographics
NPI:1962403667
Name:BHATNAGAR, GUNJAN (MD)
Entity type:Individual
Prefix:DR
First Name:GUNJAN
Middle Name:
Last Name:BHATNAGAR
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 1:33 CREEK RD
Mailing Address - Street 2:STE 270
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-7707
Mailing Address - Country:US
Mailing Address - Phone:949-559-1099
Mailing Address - Fax:949-559-1199
Practice Address - Street 1:4050 BARRANCA PKWY
Practice Address - Street 2:#210
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-7706
Practice Address - Country:US
Practice Address - Phone:949-559-1099
Practice Address - Fax:949-559-1199
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77891207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17105OtherMEDICARE GROUP ID
CA00A778970Medicaid
CAG64008Medicare UPIN
CA00A778970Medicaid